Provider Demographics
NPI:1336213537
Name:LG CHARITY HOME HEALTH CARE SERVICES, INC
Entity Type:Organization
Organization Name:LG CHARITY HOME HEALTH CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOVELINE
Authorized Official - Middle Name:MAFOR
Authorized Official - Last Name:NCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-617-2381
Mailing Address - Street 1:9535 FOREST LN STE 246
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5959
Mailing Address - Country:US
Mailing Address - Phone:469-372-0882
Mailing Address - Fax:469-420-5373
Practice Address - Street 1:2401 CALLENDER RD STE 109
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8869
Practice Address - Country:US
Practice Address - Phone:817-617-2381
Practice Address - Fax:817-617-2379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
251E00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare ID - Type Unspecified