Organization
LIFECARE HOME NURSING, LLC
Active
Other names
LifeCare Respiratory and Medical Supply Company
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY DIANE WILCOX MHSA, RN, BC, CHCE (CEO)
(903) 297-9300
Entity
Organization
Contact information
Practice address
1907 JUDSON RD, LONGVIEW, TX 75605-5607
(903) 553-1928
(903) 753-1454
Mailing address
1907 JUDSON RD, LONGVIEW, TX 75605-5607
(903) 553-1928
(903) 753-1454
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0064112
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162528701
—
TX
01
—
531610
BLUE CROSS
TX
Enumeration date
07/29/2006
Last updated
08/22/2020
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