MEDICARE: LIFELINE HOMEHEALTH CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1790653822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE HOMEHEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	322 W LAKE ST STE 223
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-5202
Country	:	US
Telephone Number	:	763-388-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 W LAKE ST STE 223
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-5202
Country	:	US
Telephone Number	:	763-388-8080
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDIRAHMAN SULEIMAN MAALIM
Credential	:
Telephone Number	:	763-388-8080

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	04/17/2026

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