Provider Demographics
NPI:1174298996
Name:LIFELINE HOLISTIC HEALTH LLC
Entity Type:Organization
Organization Name:LIFELINE HOLISTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:470-435-8524
Mailing Address - Street 1:8517 HOSPITAL DR STE E
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2433
Mailing Address - Country:US
Mailing Address - Phone:470-435-8524
Mailing Address - Fax:
Practice Address - Street 1:8517 HOSPITAL DR STE E
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2433
Practice Address - Country:US
Practice Address - Phone:470-435-8524
Practice Address - Fax:770-693-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care