Provider Demographics
NPI:1538387212
Name:LIFELINE HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:LIFELINE HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ-FORTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-756-4400
Mailing Address - Street 1:9999 NE 2ND AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2352
Mailing Address - Country:US
Mailing Address - Phone:305-756-8100
Mailing Address - Fax:786-621-4889
Practice Address - Street 1:4960 SW 52ND ST
Practice Address - Street 2:# 407-408
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-5530
Practice Address - Country:US
Practice Address - Phone:305-756-8100
Practice Address - Fax:786-621-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHME651332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1257170001Medicare NSC