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General NPI Number Information
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NPI Number | 1881761492
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Entity Type | Organization
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Legal Business Name | LIFE LINE HOME CARE INC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 100 LAKESHORE DR SUITE A
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City | SAINT MARYS
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State | GA
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Zip | 31558-3857
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Country | US
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Telephone | 912-673-8544
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Fax | 912-673-8554
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Provider Business Mailing Address
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Address Line | 1610 MADISON AVE
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City | TIFTON
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State | GA
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Zip | 31794-3756
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Country | US
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Telephone | 912-673-8544
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Fax | 912-673-8554
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONNIE C DANIEL
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Credential | PHARMD
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Telephone | 229-382-1334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 303718793
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License Number State | GA
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