MEDICARE: LIFELINE WORD HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1063354785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE WORD HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1343 ELDRON BLVD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-8517
Country	:	US
Telephone Number	:	321-497-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	1343 ELDRON BLVD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-8517
Country	:	US
Telephone Number	:	321-497-6744
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	MARIA BENNETT
Credential	:
Telephone Number	:	321-497-6744

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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