Provider Demographics
NPI:1902150980
Name:LIFESHIELD HOME CARE LLC
Entity Type:Organization
Organization Name:LIFESHIELD HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSTATAB
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-562-7803
Mailing Address - Street 1:1715 MISSION SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5059
Mailing Address - Country:US
Mailing Address - Phone:281-676-8724
Mailing Address - Fax:281-676-8724
Practice Address - Street 1:1111 HIGHWAY 6 SOUTHIMPERIAL MEDICAL CENTER, SUITE 252
Practice Address - Street 2:IMPERIAL MEDICAL CENTER, SUITE 252
Practice Address - City:SUAGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-676-8724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801639882253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care