MEDICARE: LIFELINE HOME 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1073400487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	6203 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1517
Country	:	US
Telephone Number	:	260-443-5102
Fax Number	:	260-995-7222

Provider Business Practice Location Address
First Line	:	6203 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1517
Country	:	US
Telephone Number	:	260-443-5102
Fax Number	:	260-995-7222

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SEANDRA ROBINSON
Credential	:	RN
Telephone Number	:	260-443-5102

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	03/30/2026

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