MEDICARE: LIFELINK HEALTH PROVIDERS, 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

General Provider Information

NPI Number	:	1790980969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINK HEALTH PROVIDERS, INC.

Provider Business Mailing Address
First Line	:	211 W FOOTHILL BLVD STE A
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-3357
Country	:	US
Telephone Number	:	626-387-9650
Fax Number	:	626-387-9651

Provider Business Practice Location Address
First Line	:	211 W FOOTHILL BLVD STE A
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-3357
Country	:	US
Telephone Number	:	626-387-9650
Fax Number	:	626-387-9651

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAYMOND ROMMEL S SISON
Credential	:
Telephone Number	:	626-387-9650

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	03/06/2018

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