Healthcare Provider Details

I. General information

NPI: 1619003696
Provider Name (Legal Business Name): LIFELINE HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 N SHERIDAN RD SUITE 024
CHICAGO IL
60640-1601
US

IV. Provider business mailing address

5555 N SHERIDAN RD SUITE 024
CHICAGO IL
60640-1601
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-4115
  • Fax:
Mailing address:
  • Phone: 773-271-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010427
License Number StateIL

VIII. Authorized Official

Name: MS. JONIE JOSEPHINE DESUYO
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 773-271-4115