Provider Demographics
NPI:1184009284
Name:LIFE LINE COMMUNITY HEALTHCARE
Entity Type:Organization
Organization Name:LIFE LINE COMMUNITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-581-6556
Mailing Address - Street 1:6150 OAK TREE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2569
Mailing Address - Country:US
Mailing Address - Phone:216-581-6556
Mailing Address - Fax:800-470-8713
Practice Address - Street 1:6150 OAK TREE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2569
Practice Address - Country:US
Practice Address - Phone:216-581-6556
Practice Address - Fax:800-470-8713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128594372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty