Provider Demographics
NPI:1285957613
Name:ADVANCED LIFELINE SERVICES
Entity type:Organization
Organization Name:ADVANCED LIFELINE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-426-1958
Mailing Address - Street 1:9400 WILLIAMSBURG PLZ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5093
Mailing Address - Country:US
Mailing Address - Phone:502-426-1958
Mailing Address - Fax:502-426-2337
Practice Address - Street 1:3919 S 19TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1414
Practice Address - Country:US
Practice Address - Phone:253-752-5677
Practice Address - Fax:253-756-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278S1500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedSNF/Subacute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9063397Medicaid