Provider Demographics
NPI:1811200595
Name:LIFE TIME PERSONAL CARE SERVICE
Entity Type:Organization
Organization Name:LIFE TIME PERSONAL CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DELAINE
Authorized Official - Last Name:THRASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-962-3101
Mailing Address - Street 1:1010 COMMON ST
Mailing Address - Street 2:SUITE 2660
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2401
Mailing Address - Country:US
Mailing Address - Phone:504-962-3101
Mailing Address - Fax:504-962-3102
Practice Address - Street 1:1010 COMMON ST
Practice Address - Street 2:SUITE 2660
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2401
Practice Address - Country:US
Practice Address - Phone:504-962-3101
Practice Address - Fax:504-962-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11694372500000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1887714Medicaid
LA1887552Medicaid