Provider Demographics
NPI:1679944094
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:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABORISADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-577-3395
Mailing Address - Street 1:4203 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710
Mailing Address - Country:US
Mailing Address - Phone:301-866-4115
Mailing Address - Fax:
Practice Address - Street 1:4203 58TH AVE
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1911
Practice Address - Country:US
Practice Address - Phone:301-866-4115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home