NPIMap

Organization Active NPI

Lifecare Home Nursing LLC

Doing business as LifeCare Health Services

  • Home Health Agency
  • Longview, TX
National Provider Identifier
1407864960
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LIFECARE HOME NURSING LLC
Doing business as
LifeCare Health Services
Practice address
911 W Loop 281
Suite 204
Longview, TX 75604
Phone
(903) 297-9300
Fax
(903) 297-7020
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Community Based Hospice Care Agency 251G00000X 003475 TX

Addresses

Primary practice location

911 W Loop 281
Suite 204
Longview, TX 75604

Mailing address

911 W Loop 281
Suite 204
Longview, TX 75604
Phone (903) 297-9300

Other identifiers 2

IdentifierTypeStateIssuer
HH018COtherTXBLUE CROSS BLUE SHIELD
001003838MedicaidTX

Other names 1

  • LifeCare Health Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111123000213 TX Part A Provider - Hospice 4183898471 Practice locations: Longview, TX; Nacogdoches, TX

Hospice certification: CCN 451708

Legal name
LIFECARE HOME NURSING, LLC
Doing business as
LIFECARE HEALTH SERVICES
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 6, 2001
Last certification
Dec 22, 2020
Ownership / control type
Proprietary - Individual
Organization structure
LLCProprietary
Incorporated
Jan 20, 1995 in TX
Enrollment address
911 W Loop 281
Ste 204
Longview, TX 75604-2934

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Lifecare Health ServicesCCN 451708 ยท All quality measures
Ownership
For-Profit
Certified
Sep 6, 2001
Medicare certification status
ActiveFrom the Provider of Services file

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.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Nancy Wilcox Individual 5% Or Greater Direct Ownership InterestCeo Jan 20, 1955 51%
Corporate OfficerCeo Jan 20, 1995 51%
W-2 Managing EmployeeCeo Jan 20, 1995 51%
David Wilcox Individual 5% Or Greater Direct Ownership InterestCoo Jan 20, 1995 49%
Corporate OfficerCoo Jan 20, 1995 49%
W-2 Managing EmployeeCoo Jan 20, 1995 49%

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1407864960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 W LOOP 281",
            "address_2": "SUITE 204",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75604",
            "telephone_number": "903-297-9300",
            "fax_number": "903-297-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 W LOOP 281",
            "address_2": "SUITE 204",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75604",
            "telephone_number": "903-297-9300",
            "fax_number": "903-297-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE HOME NURSING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "LYNETTE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-297-9300"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "003475",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "HH018C",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001003838",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeCare Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LifeCare Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.