Organization
LIFECARE HOME NURSING, LLC
Active
Other names
LifeCare Respiratory & Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
AMY LYNETTE WILCOX (ADMINISTRATOR / CEO)
(903) 297-9300
Entity
Organization
Contact information
Practice address
2618 NORTH ST, NACOGDOCHES, TX 75965-3501
(936) 560-3500
(936) 560-3505
Mailing address
1905 NE STALLINGS DR STE 5, NACOGDOCHES, TX 75961-3805
(936) 560-3500
(936) 560-3505
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0068227
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162528703
—
TX
Enumeration date
12/20/2006
Last updated
05/24/2021
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