Provider Demographics
NPI:1548407059
Name:LIFELINE MEDICAL STAFFING
Entity Type:Organization
Organization Name:LIFELINE MEDICAL STAFFING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GAZDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-386-2305
Mailing Address - Street 1:224 MAIN ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3188
Mailing Address - Country:US
Mailing Address - Phone:603-386-2305
Mailing Address - Fax:603-898-0726
Practice Address - Street 1:224 MAIN ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3188
Practice Address - Country:US
Practice Address - Phone:603-386-2305
Practice Address - Fax:603-898-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03468251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health