Provider Demographics
NPI:1003535469
Name:LIFELINE HEALTH, INC.
Entity Type:Organization
Organization Name:LIFELINE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-202-6052
Mailing Address - Street 1:1311 N FEDERAL HWY # 1
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3631
Mailing Address - Country:US
Mailing Address - Phone:888-202-6052
Mailing Address - Fax:
Practice Address - Street 1:1311 N FEDERAL HWY # 1
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3631
Practice Address - Country:US
Practice Address - Phone:888-202-6052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center