Healthcare Provider Details

I. General information

NPI: 1982609962
Provider Name (Legal Business Name): LIFELINE HOME HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 S 4TH ST
CHICKASHA OK
73018-4655
US

IV. Provider business mailing address

PO BOX 1348
CHICKASHA OK
73023-1348
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-4891
  • Fax: 405-224-4895
Mailing address:
  • Phone: 405-224-4891
  • Fax: 405-224-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7466
License Number StateOK

VIII. Authorized Official

Name: MS. KELLY D JEANIS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 405-224-4891