Provider Demographics
NPI:1538360409
Name:LONG LIFE HOME HEALTH CARE
Entity type:Organization
Organization Name:LONG LIFE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-291-7007
Mailing Address - Street 1:301 W BELT LINE RD
Mailing Address - Street 2:STE 103 N
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2006
Mailing Address - Country:US
Mailing Address - Phone:972-291-7007
Mailing Address - Fax:972-291-7008
Practice Address - Street 1:301 W BELT LINE RD
Practice Address - Street 2:STE 103 N
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2006
Practice Address - Country:US
Practice Address - Phone:972-291-7007
Practice Address - Fax:972-291-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX45D09820728291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered291U00000XLaboratoriesClinical Medical Laboratory