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General NPI Number Information
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NPI Number | 1518754225
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Entity Type | Organization
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Legal Business Name | LIFELINE PHARMACON
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1415 EISENHOWER BLVD
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City | JOHNSTOWN
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State | PA
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Zip | 15904-3217
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Country | US
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Telephone | 814-619-5068
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Fax |
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Provider Business Mailing Address
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Address Line | 3159 CARPENTERS PARK RD
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City | DAVIDSVILLE
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State | PA
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Zip | 15928-9223
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Country | US
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Telephone | 814-619-5068
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PATRICIA GRIESHEIMER
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Credential |
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Telephone | 814-619-5068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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