Provider Demographics
NPI:1760442305
Name:LIFE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:LIFE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:CENIZA
Authorized Official - Last Name:BUENAFLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:847-328-0702
Mailing Address - Street 1:5340 LINCOLN AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2015
Mailing Address - Country:US
Mailing Address - Phone:847-329-0702
Mailing Address - Fax:847-329-0757
Practice Address - Street 1:5340 LINCOLN AVE
Practice Address - Street 2:STE 200
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2015
Practice Address - Country:US
Practice Address - Phone:847-329-0702
Practice Address - Fax:847-329-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL147714Medicare ID - Type Unspecified