Provider Demographics
NPI:1851755987
Name:LIFE HOME, LLC
Entity Type:Organization
Organization Name:LIFE HOME, LLC
Other - Org Name:LIFE @ HOME, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-463-3595
Mailing Address - Street 1:515A WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-3105
Mailing Address - Country:US
Mailing Address - Phone:337-871-8112
Mailing Address - Fax:337-871-9013
Practice Address - Street 1:515A WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-3105
Practice Address - Country:US
Practice Address - Phone:337-871-8112
Practice Address - Fax:337-871-9013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE @ HOME, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10567253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care