Provider Demographics
NPI:1861449365
Name:LIFETIME HEALTHCARE INC
Entity Type:Organization
Organization Name:LIFETIME HEALTHCARE INC
Other - Org Name:HOME CARE OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NOE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-602-0800
Mailing Address - Street 1:1820 S MASON RD STE 320
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3243
Mailing Address - Country:US
Mailing Address - Phone:281-602-0800
Mailing Address - Fax:281-602-0806
Practice Address - Street 1:1820 S MASON RD STE 320
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3243
Practice Address - Country:US
Practice Address - Phone:281-602-0800
Practice Address - Fax:281-602-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012746OtherPHC
TX010229OtherSTATE LICENSE
TX60Q9050Medicaid
TX001012746OtherPHC
TX60Q9050Medicaid