Provider Demographics
NPI:1063054849
Name:LIFE HOME HEALTH SERVICES INC
Entity type:Organization
Organization Name:LIFE HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUCHAVCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-233-6111
Mailing Address - Street 1:17337 VENTURA BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4902
Mailing Address - Country:US
Mailing Address - Phone:747-233-1116
Mailing Address - Fax:
Practice Address - Street 1:17337 VENTURA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4902
Practice Address - Country:US
Practice Address - Phone:747-233-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-13
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty