Provider Demographics
NPI:1740696608
Name:LIFELINE, INC DBA LIFELINE HOME HEALTH
Entity type:Organization
Organization Name:LIFELINE, INC DBA LIFELINE HOME HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:YERIMA
Authorized Official - Last Name:BAKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-481-7288
Mailing Address - Street 1:6932 MARKET ST FL 1
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2340
Mailing Address - Country:US
Mailing Address - Phone:240-481-7288
Mailing Address - Fax:202-330-5605
Practice Address - Street 1:6932 MARKET ST FL 1
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2340
Practice Address - Country:US
Practice Address - Phone:240-481-7288
Practice Address - Fax:202-330-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05430501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
05430501OtherHOME HEALTH CARE