Provider Demographics
NPI:1659565893
Name:LIFELINE PARTNERS OF CANTON, INC
Entity Type:Organization
Organization Name:LIFELINE PARTNERS OF CANTON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-759-5981
Mailing Address - Street 1:PO BOX 8005
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-8005
Mailing Address - Country:US
Mailing Address - Phone:330-759-5981
Mailing Address - Fax:330-759-9677
Practice Address - Street 1:4161 STEELS POINTE
Practice Address - Street 2:SUITE 300
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6310
Practice Address - Country:US
Practice Address - Phone:330-759-5981
Practice Address - Fax:330-759-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364518Medicare Oscar/Certification