Provider Demographics
NPI:1902588478
Name:LIFE AT HOME HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:LIFE AT HOME HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NJWEIPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-577-5447
Mailing Address - Street 1:13088 BOURNE PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1000
Mailing Address - Country:US
Mailing Address - Phone:571-577-5447
Mailing Address - Fax:
Practice Address - Street 1:13088 BOURNE PL
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-1000
Practice Address - Country:US
Practice Address - Phone:571-577-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities