Provider Demographics
NPI:1689047409
Name:LIFELINE INCOPORATION
Entity Type:Organization
Organization Name:LIFELINE INCOPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HHA
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADESANOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-412-8604
Mailing Address - Street 1:502 VARNUM STREET
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710
Mailing Address - Country:US
Mailing Address - Phone:202-412-8604
Mailing Address - Fax:
Practice Address - Street 1:502 VARNUM STREET
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710
Practice Address - Country:US
Practice Address - Phone:202-412-8604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home