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Organization
LIFE LINE HOME CARE INC
Active
Organization
LIFE LINE HOME CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNIE C DANIEL PHARMD (PRESIDENT)
(229) 382-1334
Entity
Organization
Contact information
Practice address
3740 SAINT JOHNS BLUFF RD S, SUITE 1, JACKSONVILLE, FL 32224-2651
(904) 730-2202
(904) 730-2212
Mailing address
1610 MADISON AVE, TIFTON, GA 31794-3756
(904) 730-2202
(904) 730-2212
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1312767
FL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
1312767
FL
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
324181
FL
333600000X
Pharmacy
PH24359
FL
3336C0004X
Compounding Pharmacy
PH24359
FL
3336H0001X
Home Infusion Therapy Pharmacy
PH24359
FL
3336S0011X
Specialty Pharmacy
PH24359
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0942290002
MEDICARE
FL
Enumeration date
11/29/2006
Last updated
09/10/2012
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