# LIFELINE COMMUNITY SUPPORT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619580669
- **Authorized official:** MR. SERGIO ALEJANDRO VILLATORO BHCM (PRESIDENT)
- **Authorized official phone:** (786) 518-8931

## Contact information

- **Practice address:** 1666 79TH STREET CSWY STE 603, NORTH BAY VILLAGE, FL 33141-4190
- **Practice address phone:** (178) 651-8893
- **Practice address fax:** (786) 254-7303
- **Mailing address:** 1666 79TH STREET CSWY STE 603, NORTH BAY VILLAGE, FL 33141-4190
- **Mailing address phone:** (786) 518-8931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 08/28/2020
- **Last updated:** 08/18/2021