Provider Demographics
NPI:1245630417
Name:LIFELINE
Entity type:Organization
Organization Name:LIFELINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HHA
Authorized Official - Prefix:
Authorized Official - First Name:BINTU
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMBUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-323-5130
Mailing Address - Street 1:3989 WARNER AVE APT C2
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3989 WARNER AVE APT C2
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2051
Practice Address - Country:US
Practice Address - Phone:301-323-5130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health