Provider Demographics
NPI:1841462587
Name:LIFE HOME HEALTHCARE CORP
Entity type:Organization
Organization Name:LIFE HOME HEALTHCARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:SORDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-228-9555
Mailing Address - Street 1:12900 SW 128 STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6274
Mailing Address - Country:US
Mailing Address - Phone:305-253-2424
Mailing Address - Fax:305-253-2435
Practice Address - Street 1:12900 SW 128 STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6274
Practice Address - Country:US
Practice Address - Phone:305-253-2424
Practice Address - Fax:305-253-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
299992426251E00000X
251E00000X
FL299992426251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDING MEDICARE#OtherPENDING MEDICARE#