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General NPI Number Information
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NPI Number | 1265541072
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Entity Type | Organization
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Legal Business Name | LIFELINE HEALTH CARE OF CENTRAL FLORIDA, INC.
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 W MAIN ST SUITE 100
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City | LAKELAND
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State | FL
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Zip | 33815-1546
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Country | US
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Telephone | 863-603-0252
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Fax | 863-603-7853
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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 | 21960096
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License Number State | FL
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