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Organization
LIFE SPAN HOME HEALTH, LLC
Active
Organization
LIFE SPAN HOME HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEETRA MITCHELLE NELSON (ADMINISTRATOR)
(214) 342-3000
Entity
Organization
Contact information
Practice address
11325 PEGASUS ST STE S142, DALLAS, TX 75238-5239
(214) 342-3000
Mailing address
11325 PEGASUS ST STE S142, DALLAS, TX 75238-5239
(214) 342-3000
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9059
STATE PROGRAMS WAIVER
TX
Enumeration date
04/22/2009
Last updated
04/22/2009
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