Provider Demographics
NPI:1407139652
Name:LIFELINE,INC
Entity Type:Organization
Organization Name:LIFELINE,INC
Other - Org Name:LIFELINE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:YERIMA
Authorized Official - Last Name:BAKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:240-481-0448
Mailing Address - Street 1:500 GRANITE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5626
Mailing Address - Country:US
Mailing Address - Phone:240-481-7288
Mailing Address - Fax:
Practice Address - Street 1:500 GRANITE AVE #2
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5626
Practice Address - Country:US
Practice Address - Phone:240-481-7288
Practice Address - Fax:202-330-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care