MEDICARE: LIFESAVER HEALTH CARE, 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	368081	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710907704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESAVER HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	6119 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3358
Country	:	US
Telephone Number	:	614-866-5433
Fax Number	:	614-866-5456

Provider Business Practice Location Address
First Line	:	6119 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3358
Country	:	US
Telephone Number	:	614-866-5433
Fax Number	:	614-866-5456

Authorized Official
Title or Position	:	ADMINISTRATOR/DIRECTOR OF NURSING
Name	:	MRS. BARBARA GREEN
Credential	:	RN
Telephone Number	:	614-866-5433

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	04/30/2010

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