Provider Demographics
NPI:1285692343
Name:LIFELINE HOME HEALTHCARE PROVIDERS, INC.
Entity type:Organization
Organization Name:LIFELINE HOME HEALTHCARE PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-968-8842
Mailing Address - Street 1:9425 SW 72ND STREET
Mailing Address - Street 2:SUITE 237
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-263-2757
Mailing Address - Fax:305-263-2768
Practice Address - Street 1:9425 SW 72ND STREET
Practice Address - Street 2:SUITE 237
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-263-2757
Practice Address - Fax:305-263-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992088251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108237Medicare Oscar/Certification