Provider Demographics
NPI:1699766394
Name:LIFE CARE HOME HEALTH SERVICES CORPORATION
Entity type:Organization
Organization Name:LIFE CARE HOME HEALTH SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:PICKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-272-5866
Mailing Address - Street 1:800 NW 17TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2583
Mailing Address - Country:US
Mailing Address - Phone:561-272-5866
Mailing Address - Fax:561-243-3733
Practice Address - Street 1:800 NW 17TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2583
Practice Address - Country:US
Practice Address - Phone:561-272-5866
Practice Address - Fax:561-243-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2004N0530251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1671279OtherSTATE LICENSE PERMIT REG
IL2004N0530OtherNURSE AGENCY LICENSE
IL14-7664Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER