NPIMap

Organization Active NPI

Life Home LLC

  • In Home Supportive Care Agency
  • Deridder, LA
National Provider Identifier
1144509068
Registry record updated Aug 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
10567 Issued in LA
Legal business name
LIFE HOME LLC
Practice address
736 N Pine St
Deridder, LA 70634-2812
Phone
(337) 463-3595
Fax
(337) 463-3919
NPI assigned
Aug 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

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

Authorized official

Name
Mrs. Daisy Washington Holmes, MSN RN
Title
Executive Director
Phone
(337) 463-3595

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X 10567 LA Primary
In Home Supportive Care Agency 253Z00000X 12351 LA
In Home Supportive Care Agency 253Z00000X 12217 LA
In Home Supportive Care Agency 253Z00000X 12352 LA

Addresses

Primary practice location

736 N Pine St
Deridder, LA 70634-2812

Mailing address

736 N Pine St
Deridder, LA 70634-2812
Phone (337) 463-3595

Other identifiers 7

IdentifierTypeStateIssuer
1118036MedicaidLA
1118541MedicaidLA
1134767MedicaidLA
1179299MedicaidLA
1460591MedicaidLA
1466841MedicaidLA
1122734MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Life Home LLC16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312848000000",
    "number": "1144509068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "736 N PINE ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706342812",
            "telephone_number": "337-463-3595",
            "fax_number": "337-463-3919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 N PINE ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706342812",
            "telephone_number": "337-463-3595",
            "fax_number": "337-463-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-09",
        "last_updated": "2011-08-09",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "DAISY",
        "authorized_official_middle_name": "WASHINGTON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "337-463-3595",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSN RN"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "LA",
            "license": "10567",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "LA",
            "license": "12351",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "LA",
            "license": "12217",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "LA",
            "license": "12352",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1118036",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1118541",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134767",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1179299",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1460591",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1466841",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1122734",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deridder, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; 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.