Provider Demographics
NPI:1821986712
Name:LIFTED LIVING CARE
Entity type:Organization
Organization Name:LIFTED LIVING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRIONA
Authorized Official - Middle Name:NECCO
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-463-3110
Mailing Address - Street 1:3531 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4262
Mailing Address - Country:US
Mailing Address - Phone:937-463-3110
Mailing Address - Fax:
Practice Address - Street 1:3531 CORNELL DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4262
Practice Address - Country:US
Practice Address - Phone:937-463-3110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IVY LEAGUE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health