Provider Demographics
NPI:1629711502
Name:LIFELINE MED-TRANSPORTATION,LLC
Entity Type:Organization
Organization Name:LIFELINE MED-TRANSPORTATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHHETRI
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:216-820-5878
Mailing Address - Street 1:4387 VALLEYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1047
Mailing Address - Country:US
Mailing Address - Phone:216-820-5878
Mailing Address - Fax:
Practice Address - Street 1:4387 VALLEYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1047
Practice Address - Country:US
Practice Address - Phone:216-820-5878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFELINE MED-TRANSPORTATION,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1033867726Medicaid