Provider Demographics
NPI:1962801449
Name:LIFETIME QUALITY CARE LLC
Entity type:Organization
Organization Name:LIFETIME QUALITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PA KOU
Authorized Official - Middle Name:CHEE
Authorized Official - Last Name:THAOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-287-2207
Mailing Address - Street 1:2258 CALUMET DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4604
Mailing Address - Country:US
Mailing Address - Phone:920-287-2207
Mailing Address - Fax:
Practice Address - Street 1:2258 CALUMET DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4604
Practice Address - Country:US
Practice Address - Phone:920-287-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health