NPIMap

Organization Active NPI

Lifecare Home Nursing, LLC

Doing business as LifeCare Respiratory & Medical Supply

  • Durable Medical Equipment & Medical Supplies
  • Nacogdoches, TX
National Provider Identifier
1114081619
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
0068227 Issued in TX
Legal business name
LIFECARE HOME NURSING, LLC
Doing business as
LifeCare Respiratory & Medical Supply
Practice address
2618 North St
Nacogdoches, TX 75965-3501
Phone
(936) 560-3500
Fax
(936) 560-3505
NPI assigned
Dec 20, 2006
Last updated
May 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy Lynette Wilcox
Title
Administrator / Ceo
Phone
(903) 297-9300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 0068227 TX Primary

Addresses

Primary practice location

2618 North St
Nacogdoches, TX 75965-3501

Mailing address

1905 NE Stallings Dr Ste 5
Nacogdoches, TX 75961-3805
Phone (936) 560-3500

Other identifiers 1

IdentifierTypeStateIssuer
162528703MedicaidTX

Other names 1

  • LifeCare Respiratory & Medical Supply Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lifecare Health Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2618 North St
Nacogdoches, TX 75965
Phone (936) 560-3500

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1114081619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 NE STALLINGS DR STE 5",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759613805",
            "telephone_number": "936-560-3500",
            "fax_number": "936-560-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2618 NORTH ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759653501",
            "telephone_number": "936-560-3500",
            "fax_number": "936-560-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE HOME NURSING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "LYNETTE",
        "authorized_official_title_or_position": "ADMINISTRATOR / CEO",
        "authorized_official_telephone_number": "903-297-9300"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0068227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "162528703",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeCare Respiratory & Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LifeCare Respiratory & Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nacogdoches, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.