Provider Demographics
NPI:1154318509
Name:LIFELINE THERAPY, LLC
Entity Type:Organization
Organization Name:LIFELINE THERAPY, LLC
Other - Org Name:LIFELINE THERAPY MCMURRAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-829-2450
Mailing Address - Street 1:100 FOREST HILLS PLZ
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-5211
Mailing Address - Country:US
Mailing Address - Phone:412-829-2450
Mailing Address - Fax:412-829-2468
Practice Address - Street 1:4000 WATERDAM PLAZA DRIVE
Practice Address - Street 2:SUITE 260
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317
Practice Address - Country:US
Practice Address - Phone:724-941-5340
Practice Address - Fax:724-941-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394539Medicare ID - Type UnspecifiedMEDICARE CORF NUMBER