Provider Demographics
NPI:1841403375
Name:LONG LIFE HOME CARE INC
Entity Type:Organization
Organization Name:LONG LIFE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-267-0055
Mailing Address - Street 1:5545 SW 8TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2274
Mailing Address - Country:US
Mailing Address - Phone:305-267-0055
Mailing Address - Fax:305-267-0066
Practice Address - Street 1:5545 SW 8TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2274
Practice Address - Country:US
Practice Address - Phone:305-267-0055
Practice Address - Fax:305-267-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992757251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109303Medicare PIN