Provider Demographics
NPI:1851396436
Name:LIFELINE COORDINATING SERVICES, INC.
Entity Type:Organization
Organization Name:LIFELINE COORDINATING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-771-1193
Mailing Address - Street 1:1459 ENGLISH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1122
Mailing Address - Country:US
Mailing Address - Phone:651-771-1193
Mailing Address - Fax:651-771-1657
Practice Address - Street 1:1459 ENGLISH ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-1122
Practice Address - Country:US
Practice Address - Phone:651-771-1193
Practice Address - Fax:651-771-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies