Provider Demographics
NPI:1497561039
Name:LYFETYME HOME CARE LLC
Entity type:Organization
Organization Name:LYFETYME HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:HOLLIMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-998-3024
Mailing Address - Street 1:218 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4649
Mailing Address - Country:US
Mailing Address - Phone:757-998-3024
Mailing Address - Fax:
Practice Address - Street 1:218 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4649
Practice Address - Country:US
Practice Address - Phone:757-998-3024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care