Healthcare Provider Details

I. General information

NPI: 1528026226
Provider Name (Legal Business Name): LIFE LINE HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 TIFT AVE N STE 101
TIFTON GA
31794-1884
US

IV. Provider business mailing address

1610 MADISON AVE
TIFTON GA
31794-3756
US

V. Phone/Fax

Practice location:
  • Phone: 229-382-1334
  • Fax: 229-382-1350
Mailing address:
  • Phone: 229-382-1334
  • Fax: 229-382-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHRE007390
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number1370
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberPHRE007390
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHRE007390
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number322562
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1370
License Number StateFL

VIII. Authorized Official

Name: DR. RONNIE C DANIEL
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 229-382-1334