Provider Demographics
NPI:1770058141
Name:LIFELINE SCIENCES LLC
Entity type:Organization
Organization Name:LIFELINE SCIENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-825-3431
Mailing Address - Street 1:38955 HILLS TECH DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3431
Mailing Address - Country:US
Mailing Address - Phone:248-825-3431
Mailing Address - Fax:
Practice Address - Street 1:24748 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2109
Practice Address - Country:US
Practice Address - Phone:313-278-1820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFELINE SCIENCES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty