Provider Demographics
NPI:1962283085
Name:LIFEFORTE HOMECARE LLC
Entity type:Organization
Organization Name:LIFEFORTE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUFEYISETAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-770-0110
Mailing Address - Street 1:205 E US HIGHWAY 80 STE 145
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 FEDERAL ST STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-8206
Practice Address - Country:US
Practice Address - Phone:207-770-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care