Provider Demographics
NPI:1073008363
Name:LIFELINE NURSING AGENCY, INC.
Entity Type:Organization
Organization Name:LIFELINE NURSING AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHISTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-595-7221
Mailing Address - Street 1:5119 BRIARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5119 BRIARWOOD RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7626
Practice Address - Country:US
Practice Address - Phone:224-888-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILHF114153251E00000X, 251J00000X
IL4000556251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1073008363OtherBLUE CROSS BLUE SHIELD OF IL
IL4000556OtherILLINOIS DEPT OF PUBLIC HEALTH