Provider Demographics
NPI:1619003696
Name:LIFELINE HEALTH CARE, INC.
Entity Type:Organization
Organization Name:LIFELINE HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JONIE JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESUYO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-271-4115
Mailing Address - Street 1:5555 N SHERIDAN RD
Mailing Address - Street 2:SUITE 024
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1601
Mailing Address - Country:US
Mailing Address - Phone:773-271-4115
Mailing Address - Fax:
Practice Address - Street 1:5555 N SHERIDAN RD
Practice Address - Street 2:SUITE 024
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1601
Practice Address - Country:US
Practice Address - Phone:773-271-4115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010427251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147919Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER