Provider Demographics
NPI:1154352482
Name:LIFE LINE PARTNERS, INC
Entity type:Organization
Organization Name:LIFE LINE PARTNERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURGDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-759-9233
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-0119
Mailing Address - Country:US
Mailing Address - Phone:330-759-9233
Mailing Address - Fax:330-759-9677
Practice Address - Street 1:1825 TIBBETTS WICK RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1222
Practice Address - Country:US
Practice Address - Phone:330-759-9233
Practice Address - Fax:330-759-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0090482251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2198643Medicaid
OH000000220269OtherANTHEM
OH364513Medicare ID - Type Unspecified
OH2198643Medicaid