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General NPI Number Information
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NPI Number | 1912002379
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Entity Type | Organization
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Legal Business Name | LIFELINE HOME HEALTH CARE OF LAKELAND, LLC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 5129 S. LAKELAND DR SUITE 3
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City | LAKELAND
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State | FL
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Zip | 33813-2599
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Country | US
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Telephone | 863-646-7481
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Fax | 863-646-7362
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-233-1307
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Fax | 337-233-5764
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. PETER C. NOVEMBER II
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Credential |
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Telephone | 337-233-1307
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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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