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General NPI Number Information
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NPI Number | 1023326436
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Entity Type | Organization
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Legal Business Name | LIFELINE HOMECARE OF SALEM LLC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 503 E MAIN ST
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City | SALEM
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State | KY
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Zip | 42078-8033
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Country | US
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Telephone | 270-988-0133
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Fax | 270-988-0139
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-233-1307
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Fax | 337-233-5764
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | PETER C NOVEMBER II
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Credential |
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Telephone | 337-233-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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