Provider Demographics
NPI:1134255979
Name:LIFEPATH HOSPICE AND PALLIATIVE CARE, INC
Entity type:Organization
Organization Name:LIFEPATH HOSPICE AND PALLIATIVE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP FINANCE AND OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:8138-718-7777
Mailing Address - Street 1:115 S MISSOURI AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-4600
Mailing Address - Country:US
Mailing Address - Phone:863-682-0027
Mailing Address - Fax:
Practice Address - Street 1:115 S MISSOURI AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-4600
Practice Address - Country:US
Practice Address - Phone:863-682-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based