Provider Demographics
NPI:1396750253
Name:LIFECARE HOME NURSING, LLC
Entity type:Organization
Organization Name:LIFECARE HOME NURSING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-297-9300
Mailing Address - Street 1:911 W LOOP 281 STE 204
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2934
Mailing Address - Country:US
Mailing Address - Phone:903-297-9300
Mailing Address - Fax:903-297-7020
Practice Address - Street 1:911 W LOOP 281 STE 204
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2934
Practice Address - Country:US
Practice Address - Phone:903-297-9300
Practice Address - Fax:903-297-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 253Z00000X
TX003475251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH168HOtherBLUE CROSS HOME HEALTH
TX5123325OtherAETNA HOME HEALTH
TX135252OtherGENTIVA HOME HEALTH
TX5123325OtherAETNA HOME HEALTH