Provider Demographics
NPI:1770206906
Name:LIFELINE HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:LIFELINE HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRAKA
Authorized Official - Middle Name:NIRE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-830-7483
Mailing Address - Street 1:6636 AUSTIN PEAY HWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9613
Mailing Address - Country:US
Mailing Address - Phone:901-830-7483
Mailing Address - Fax:
Practice Address - Street 1:6636 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9613
Practice Address - Country:US
Practice Address - Phone:901-830-7483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health