Healthcare Provider Details

I. General information

NPI: 1750588760
Provider Name (Legal Business Name): LIFELINE HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 LEE HWY SUITE 206
CENTREVILLE VA
20121
US

IV. Provider business mailing address

14701 LEE HWY SUITE 206
CENTREVILLE VA
20121-2133
US

V. Phone/Fax

Practice location:
  • Phone: 703-543-7511
  • Fax:
Mailing address:
  • Phone: 703-543-7511
  • Fax: 703-543-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateVA

VIII. Authorized Official

Name: MS. IRENE OSEI
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 703-543-7511