Provider Demographics
NPI:1801170949
Name:HOME LIFE SENIOR CARE
Entity type:Organization
Organization Name:HOME LIFE SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-556-0224
Mailing Address - Street 1:740 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3647
Mailing Address - Country:US
Mailing Address - Phone:469-556-0224
Mailing Address - Fax:469-656-1502
Practice Address - Street 1:740 YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3647
Practice Address - Country:US
Practice Address - Phone:469-556-0224
Practice Address - Fax:469-656-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care