Provider Demographics
NPI:1912586389
Name:LIFELINE RECOVERY CENTER, INC.
Entity Type:Organization
Organization Name:LIFELINE RECOVERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:RUBEENE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-227-1745
Mailing Address - Street 1:PO BOX 7652
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 UPSHAW LANE
Practice Address - Street 2:
Practice Address - City:KEVIL
Practice Address - State:KY
Practice Address - Zip Code:42053
Practice Address - Country:US
Practice Address - Phone:270-443-4743
Practice Address - Fax:270-477-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility