Provider Demographics
NPI:1629369418
Name:LIFE LINE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LIFE LINE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-410-0076
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-1140
Mailing Address - Country:US
Mailing Address - Phone:787-410-0076
Mailing Address - Fax:787-621-4439
Practice Address - Street 1:1046 AVE. LOS ASTROS - GOLDEN HILL
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-1046
Practice Address - Country:US
Practice Address - Phone:787-410-0076
Practice Address - Fax:787-621-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies