Healthcare Provider Details

I. General information

NPI: 1164871497
Provider Name (Legal Business Name): LIFELINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 GEORGIA AVE NW
WASHINGTON DC
20001-3862
US

IV. Provider business mailing address

2833 GEORGIA AVE NW
WASHINGTON DC
20001-3862
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA12034
License Number StateDC

VIII. Authorized Official

Name: BASSEY BASSEY
Title or Position: HUMAN RESOURCES MANAGER
Credential: HUMAN RESOURCES
Phone: 202-588-8036