Provider Demographics
NPI:1194395541
Name:LIFELINE RESPIRATORY SERVICES LLC
Entity Type:Organization
Organization Name:LIFELINE RESPIRATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:406-836-0718
Mailing Address - Street 1:150 TOWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-6495
Mailing Address - Country:US
Mailing Address - Phone:406-836-0718
Mailing Address - Fax:
Practice Address - Street 1:150 TOWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-6495
Practice Address - Country:US
Practice Address - Phone:406-836-0718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome HealthGroup - Single Specialty