Healthcare Provider Details

I. General information

NPI: 1083201727
Provider Name (Legal Business Name): LIFELINE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 KENILWORTH AVE NE
WASHINGTON DC
20019-2010
US

IV. Provider business mailing address

3200 SAINT LUKES LN
GWYNN OAK MD
21207-5629
US

V. Phone/Fax

Practice location:
  • Phone: 202-588-8036
  • Fax:
Mailing address:
  • Phone: 443-939-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. RHODA MAKINDE
Title or Position: DIRECTOR
Credential:
Phone: 202-588-8036