MEDICARE: LIFELINE CONCORD 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	341600000X	Ambulance

General Provider Information

NPI Number	:	1205346319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE CONCORD LLC

Provider Business Mailing Address
First Line	:	3737 CHASE AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-4008
Country	:	US
Telephone Number	:	847-933-9348
Fax Number	:	847-933-9319

Provider Business Practice Location Address
First Line	:	1340 JOHN A PAPALAS DR
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1356
Country	:	US
Telephone Number	:	313-386-9400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOHN J HERLIHY
Credential	:
Telephone Number	:	847-933-9348

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	01/13/2022

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