Healthcare Provider Details

I. General information

NPI: 1538822218
Provider Name (Legal Business Name): LYFELINES CERTIFICATION AND STAFFING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GENE REED RD STE 103
BIRMINGHAM AL
35215-8260
US

IV. Provider business mailing address

500 GENE REED RD STE 103
BIRMINGHAM AL
35215-8260
US

V. Phone/Fax

Practice location:
  • Phone: 205-407-5718
  • Fax: 205-407-5802
Mailing address:
  • Phone: 205-407-5718
  • Fax: 205-407-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIESHA GRESHAM
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 205-407-5718