Healthcare Provider Details

I. General information

NPI: 1710894332
Provider Name (Legal Business Name): LIFELINE COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 COBURN LN
APPOMATTOX VA
24522-5386
US

IV. Provider business mailing address

195 COBURN LN
APPOMATTOX VA
24522-5386
US

V. Phone/Fax

Practice location:
  • Phone: 434-509-8855
  • Fax:
Mailing address:
  • Phone: 434-509-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TYSHA SCOTT
Title or Position: MANAGING MEMBER/OWNER
Credential:
Phone: 434-509-8855