Healthcare Provider Details

I. General information

NPI: 1144407578
Provider Name (Legal Business Name): LIFELINE SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W LIBERTY ST STE 2
SUMTER SC
29150-5181
US

IV. Provider business mailing address

PO BOX 3792
SUMTER SC
29151-3792
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-7414
  • Fax: 803-774-6325
Mailing address:
  • Phone: 803-774-7414
  • Fax: 803-774-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA CHERYL WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-774-7414