MEDICARE: LIFELINE HOME HEALTH CARE OF LEXINGTON, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QR0400X	Rehabilitation Clinic/Center
2	261QR1300X	Rural Health Clinic/Center
3	3747P1801X	Personal Care Attendant
4	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000503513	OTHER	KY	ANTHEM BLUE CROSS BLUE SH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558395335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE HOME HEALTH CARE OF LEXINGTON, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-233-5764

Provider Business Practice Location Address
First Line	:	100 JOHN SUTHERLAND DR STE 8
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-2424
Country	:	US
Telephone Number	:	859-272-9787
Fax Number	:	859-272-4698

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	NICHOLAS GACHASSIN III
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/13/2022

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Directions to “LIFELINE HOME HEALTH CARE OF LEXINGTON, LLC ” Practice Location

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