Provider Demographics
NPI:1962755991
Name:LIFELINE INC DBA LIFELINE HOME HEALTH
Entity type:Organization
Organization Name:LIFELINE INC DBA LIFELINE HOME HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BAKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:202-722-0404
Mailing Address - Street 1:353 HERITAGE PARK TRCE NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4832
Mailing Address - Country:US
Mailing Address - Phone:240-350-7378
Mailing Address - Fax:202-330-5605
Practice Address - Street 1:6210 N CAPITOL ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1416
Practice Address - Country:US
Practice Address - Phone:202-722-0404
Practice Address - Fax:202-330-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========0Medicare NSC