Provider Demographics
NPI:1932107786
Name:LIPET HOME CARE, INC.
Entity Type:Organization
Organization Name:LIPET HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PET
Authorized Official - Middle Name:EBERE
Authorized Official - Last Name:ANAMEGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:817-794-5959
Mailing Address - Street 1:2008 E RANDOL MILL RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-8205
Mailing Address - Country:US
Mailing Address - Phone:817-794-5959
Mailing Address - Fax:817-594-0999
Practice Address - Street 1:2008 E RANDOL MILL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-8205
Practice Address - Country:US
Practice Address - Phone:817-794-5959
Practice Address - Fax:817-794-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251E00000X, 251J00000X, 253Z00000X, 372600000X, 3747P1801X, 374U00000X, 376J00000X, 385H00000X
TX010363251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679319Medicare ID - Type UnspecifiedHOME HEALTH AGENCY