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General NPI Number Information
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NPI Number | 1932104817
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Entity Type | Organization
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Legal Business Name | LIFELINE PRIVATE DUTY HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 917 S 4TH ST
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City | CHICKASHA
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State | OK
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Zip | 73018-4655
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Country | US
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Telephone | 405-224-4891
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Fax | 405-224-4895
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Provider Business Mailing Address
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Address Line | PO BOX 1348
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City | CHICKASHA
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State | OK
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Zip | 73023-1348
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Country | US
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Telephone | 405-224-4891
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Fax | 405-224-4895
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KELLY D JEANIS
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Credential | RN
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Telephone | 405-224-4891
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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 | 7471
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License Number State | OK
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