Provider Demographics
NPI:1154400257
Name:LIFE @ HOME, LLC
Entity type:Organization
Organization Name:LIFE @ HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:337-462-2745
Mailing Address - Street 1:736 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-2812
Mailing Address - Country:US
Mailing Address - Phone:337-462-2745
Mailing Address - Fax:337-462-2746
Practice Address - Street 1:736 N PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-2812
Practice Address - Country:US
Practice Address - Phone:337-462-2745
Practice Address - Fax:337-462-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12352251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1118036Medicaid