Provider Demographics
NPI:1609023969
Name:LIFELINE PARTNERS, INC
Entity Type:Organization
Organization Name:LIFELINE PARTNERS, INC
Other - Org Name:LLP YOUNGSTOWN SLEEP LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-759-9233
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-0119
Mailing Address - Country:US
Mailing Address - Phone:330-759-9233
Mailing Address - Fax:330-759-9677
Practice Address - Street 1:397 CHURCHILL HUBBARD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1375
Practice Address - Country:US
Practice Address - Phone:330-759-9233
Practice Address - Fax:330-759-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHID01991Medicare PIN