Healthcare Provider Details

I. General information

NPI: 1477367936
Provider Name (Legal Business Name): LIFELINE HOME SUPPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 ROCHE DR
COLUMBUS OH
43229-3272
US

IV. Provider business mailing address

5437 MAHONING AVE
YOUNGSTOWN OH
44515-2437
US

V. Phone/Fax

Practice location:
  • Phone: 330-853-8627
  • Fax:
Mailing address:
  • Phone: 330-797-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SASI KAZA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 330-990-0960