Provider Demographics
NPI:1750750733
Name:LIFELINE INCOPORATION
Entity type:Organization
Organization Name:LIFELINE INCOPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HHA
Authorized Official - Prefix:
Authorized Official - First Name:OUWAKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-825-2189
Mailing Address - Street 1:4213 OGLETHORPE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1540
Mailing Address - Country:US
Mailing Address - Phone:240-898-6687
Mailing Address - Fax:
Practice Address - Street 1:4213 OGLETHORPE ST APT 4
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1540
Practice Address - Country:US
Practice Address - Phone:240-898-6687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home