Provider Demographics
NPI:1700061314
Name:LIFELINE, INC
Entity Type:Organization
Organization Name:LIFELINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-927-7580
Mailing Address - Street 1:1615 KENILWORTH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-2010
Mailing Address - Country:US
Mailing Address - Phone:202-588-8036
Mailing Address - Fax:202-588-8038
Practice Address - Street 1:5632 ANNAPOLIS RD STE 9
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2213
Practice Address - Country:US
Practice Address - Phone:301-927-7580
Practice Address - Fax:301-927-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC098040892Medicaid
DC012805035Medicaid
DC036436500Medicaid