Provider Demographics
NPI:1790148740
Name:LIFELINC DIRECT CARE PLLC
Entity Type:Organization
Organization Name:LIFELINC DIRECT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-844-1590
Mailing Address - Street 1:3340 PLAYERS CLUB PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8933
Mailing Address - Country:US
Mailing Address - Phone:866-362-6963
Mailing Address - Fax:866-362-4202
Practice Address - Street 1:2207 MOODY RIDGE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4113
Practice Address - Country:US
Practice Address - Phone:256-912-0341
Practice Address - Fax:256-912-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty