Provider Demographics
NPI:1588932529
Name:LIFEHOUSE COMMUNITY CARE, LLC
Entity type:Organization
Organization Name:LIFEHOUSE COMMUNITY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:N
Authorized Official - Last Name:GREMO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-315-9007
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-0135
Mailing Address - Country:US
Mailing Address - Phone:860-315-9007
Mailing Address - Fax:
Practice Address - Street 1:554 LIBERTY HIGHWAY UNIT 2
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260
Practice Address - Country:US
Practice Address - Phone:860-315-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54539580251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health