Provider Demographics
NPI:1255321527
Name:LIFELINE HEALTHCARE SERVICES,INC
Entity Type:Organization
Organization Name:LIFELINE HEALTHCARE SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN / ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:I
Authorized Official - Last Name:ALAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-724-2866
Mailing Address - Street 1:2000 N CENTRAL EXPY STE 105
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5484
Mailing Address - Country:US
Mailing Address - Phone:972-423-8500
Mailing Address - Fax:972-423-6600
Practice Address - Street 1:2000 N CENTRAL EXPY STE 105
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5484
Practice Address - Country:US
Practice Address - Phone:972-423-5000
Practice Address - Fax:972-423-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009311251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009311Medicaid
TX09311Medicaid