Organization
LIFELINE RESOURCES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT A KELLY (OWNER/VICE-PRESIDENT)
(515) 256-8001
Entity
Organization
Contact information
Practice address
3125 DOUGLAS AVE STE 100, DES MOINES, IA 50310-5310
(515) 256-8001
(515) 256-8082
Mailing address
3125 DOUGLAS AVE STE 100, DES MOINES, IA 50310-5310
(515) 256-8001
(515) 256-8082
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
02581
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015180
—
IA
05
—
0401892
—
IA
05
—
0401894
—
IA
01
—
600013244
MAGELLAN
IA
Enumeration date
01/12/2007
Last updated
07/01/2013
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