Provider Demographics
NPI:1972981090
Name:LIFELINE HOME HEALTH INC
Entity type:Organization
Organization Name:LIFELINE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUGENIE
Authorized Official - Middle Name:MBOUTCHOCK
Authorized Official - Last Name:KABIWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-442-5796
Mailing Address - Street 1:4309 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5282
Mailing Address - Country:US
Mailing Address - Phone:301-442-5796
Mailing Address - Fax:
Practice Address - Street 1:4309 KENWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193
Practice Address - Country:US
Practice Address - Phone:301-442-5796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2407251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health