Organization
LIFE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DAISY WASHINGTON HOLMES MSN RN (EXECUTIVE DIRECTOR)
(337) 463-3595
Entity
Organization
Contact information
Practice address
736 N PINE ST, DERIDDER, LA 70634-2812
(337) 463-3595
(337) 463-3919
Mailing address
736 N PINE ST, DERIDDER, LA 70634-2812
(337) 463-3595
(337) 463-3919
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
10567
LA
253Z00000X
In Home Supportive Care Agency
12217
LA
253Z00000X
In Home Supportive Care Agency
12351
LA
253Z00000X
In Home Supportive Care Agency
12352
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1118036
—
LA
05
—
1118541
—
LA
05
—
1122734
—
LA
05
—
1134767
—
LA
05
—
1179299
—
LA
05
—
1460591
—
LA
05
—
1466841
—
LA
Enumeration date
08/09/2011
Last updated
08/09/2011
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