Provider Demographics
NPI:1285170019
Name:LIFECARE HOME NURSING LLC
Entity type:Organization
Organization Name:LIFECARE HOME NURSING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-297-9300
Mailing Address - Street 1:911 W LOOP 281
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2900
Mailing Address - Country:US
Mailing Address - Phone:903-297-9300
Mailing Address - Fax:903-297-7020
Practice Address - Street 1:911 W LOOP 281
Practice Address - Street 2:SUITE 204
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2900
Practice Address - Country:US
Practice Address - Phone:903-297-9300
Practice Address - Fax:903-297-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003475251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396750253Medicaid
TX1396750253Medicaid