Provider Demographics
NPI:1295912129
Name:LIRA HOME CORPORATION
Entity type:Organization
Organization Name:LIRA HOME CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KATSENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-232-1986
Mailing Address - Street 1:4125 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2447
Mailing Address - Country:US
Mailing Address - Phone:352-683-9784
Mailing Address - Fax:352-683-9784
Practice Address - Street 1:4125 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-2447
Practice Address - Country:US
Practice Address - Phone:352-683-9784
Practice Address - Fax:352-683-9784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906179320600000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities