MEDICARE: LIFELINE HEALTH CARE, INC.

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	1010427	IL

General Provider Information

NPI Number	:	1619003696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	5555 N SHERIDAN RD
Second Line	:	SUITE 024
City	:	CHICAGO
State	:	IL
Zip	:	60640-1601
Country	:	US
Telephone Number	:	773-271-4115
Fax Number	:

Provider Business Practice Location Address
First Line	:	5555 N SHERIDAN RD
Second Line	:	SUITE 024
City	:	CHICAGO
State	:	IL
Zip	:	60640-1601
Country	:	US
Telephone Number	:	773-271-4115
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. JONIE JOSEPHINE DESUYO
Credential	:	RN
Telephone Number	:	773-271-4115

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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