=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689227670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFELINE HOME HEALTHCARE & NURSING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2019
-----------------------------------------------------
Last Update Date | 07/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 WILMINGTON W CHESTER PIKE STE 200
-----------------------------------------------------
City | CHADDS FORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19317-9011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-465-8072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 N RADNOR CHESTER RD STE F200
-----------------------------------------------------
City | RADNOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19087-5245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SANDRA BILLOPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-740-4069
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------