Provider Demographics
NPI:1104295187
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:NICHEU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIENJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-776-8456
Mailing Address - Street 1:6823D RIVERDALE RD APT D1
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6823D RIVERDALE RD APT D1
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1835
Practice Address - Country:US
Practice Address - Phone:301-898-7756
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