Provider Demographics
NPI:1194193615
Name:LIFELINE INCOPORATION
Entity Type:Organization
Organization Name:LIFELINE INCOPORATION
Other - Org Name:LIFELINE INCOPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:HHA
Authorized Official - Prefix:
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-772-8778
Mailing Address - Street 1:5201 SHERIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 SHERIFF RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5583
Practice Address - Country:US
Practice Address - Phone:240-772-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility