Provider Demographics
NPI:1770579468
Name:LIFELINE THERAPY WARRENDALE, LLC
Entity type:Organization
Organization Name:LIFELINE THERAPY WARRENDALE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-829-2450
Mailing Address - Street 1:100 FOREST HILLS PLZ
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-5211
Mailing Address - Country:US
Mailing Address - Phone:412-829-2450
Mailing Address - Fax:412-829-2468
Practice Address - Street 1:100 FOWLER RD STE 40
Practice Address - Street 2:
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-1132
Practice Address - Country:US
Practice Address - Phone:724-933-3280
Practice Address - Fax:724-933-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394563Medicare ID - Type UnspecifiedMEDICARE CORF NUMBER