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General NPI Number Information
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NPI Number | 1154354595
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Entity Type | Organization
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Legal Business Name | LIFELINE HEALTH CARE OF KENTUCKY #3, INC.
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 60 SHELTON LN
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-7203
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Country | US
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Telephone | 270-726-2408
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Fax | 270-726-7213
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Provider Business Mailing Address
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Address Line | 600 CLIFTY ST
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City | SOMERSET
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State | KY
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Zip | 42503-1733
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Country | US
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Telephone | 606-679-4100
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Fax | 606-678-7306
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES T. WILSON
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Credential |
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Telephone | 606-679-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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