Healthcare Provider Details

I. General information

NPI: 1912738436
Provider Name (Legal Business Name): LIFELINE PPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3866 JULNAR AVE
NORTH PORT FL
34286
US

IV. Provider business mailing address

1181 S SUMTER BLVD STE 317
NORTH PORT FL
34287-2335
US

V. Phone/Fax

Practice location:
  • Phone: 800-940-0661
  • Fax:
Mailing address:
  • Phone: 800-940-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BORZA
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential:
Phone: 800-940-0661