Provider Demographics
NPI:1376348821
Name:LIFESOURCE HOMECARE INC
Entity type:Organization
Organization Name:LIFESOURCE HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SADE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYOADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-704-9001
Mailing Address - Street 1:16349 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1302
Mailing Address - Country:US
Mailing Address - Phone:610-704-9001
Mailing Address - Fax:
Practice Address - Street 1:16349 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1302
Practice Address - Country:US
Practice Address - Phone:610-704-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care