1750588760 NPI number — LIFELINE HOME CARE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750588760 NPI number — LIFELINE HOME CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFELINE HOME CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750588760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14701 LEE HWY
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
CENTREVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20121-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-543-7511
Provider Business Mailing Address Fax Number:
703-543-7512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14701 LEE HWY
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
CENTREVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-543-7511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OSEI
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
703-543-7511

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0103784358 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".