1861492332 NPI number — LIFEPATH HOME HEALTH CARE, LLC

Table of content: (NPI 1861492332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861492332 NPI number — LIFEPATH HOME HEALTH CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEPATH HOME HEALTH CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861492332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
491 WILLIAMSON ROAD,
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
MOORESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28117-9252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-664-2876
Provider Business Mailing Address Fax Number:
801-263-9929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5801 FASHION BLVD.
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-6159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-293-0444
Provider Business Practice Location Address Fax Number:
801-263-9929
Provider Enumeration Date:
07/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ABELL
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
SECRETARY AND GENERAL COUNSEL
Authorized Official Telephone Number:
704-664-2876

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  002902 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)