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General NPI Number Information
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NPI Number | 1710894332
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Entity Type | Organization
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Legal Business Name | LIFELINE COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 195 COBURN LN
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City | APPOMATTOX
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State | VA
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Zip | 24522-5386
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Country | US
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Telephone | 434-509-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 195 COBURN LN
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City | APPOMATTOX
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State | VA
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Zip | 24522-5386
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Country | US
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Telephone | 434-509-8855
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER/OWNER
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Name | TYSHA SCOTT
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Credential |
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Telephone | 434-509-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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