Healthcare Provider Details

I. General information

NPI: 1700061314
Provider Name (Legal Business Name): LIFELINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 ANNAPOLIS RD STE 9
BLADENSBURG MD
20710-2213
US

IV. Provider business mailing address

1615 KENILWORTH AVE NE
WASHINGTON DC
20019-2010
US

V. Phone/Fax

Practice location:
  • Phone: 301-927-7580
  • Fax: 301-927-7583
Mailing address:
  • Phone: 202-588-8036
  • Fax: 202-588-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. RHODA MAKINDE
Title or Position: MANAGER
Credential:
Phone: 301-927-7580