MEDICARE: LIFELINE RESOURCE GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	251S00000X	Community/Behavioral Health Agency
3	347E00000X	Transportation Broker
4	342000000X	Transportation Network Company

General Provider Information

NPI Number	:	1952177008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE RESOURCE GROUP INC

Provider Business Mailing Address
First Line	:	2925 RICHMOND AVE STE 1200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3143
Country	:	US
Telephone Number	:	713-252-8332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 RICHMOND AVE STE 1200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3143
Country	:	US
Telephone Number	:	713-252-8332
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. SONIA DENISE TIMS
Credential	:
Telephone Number	:	713-252-8332

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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