Organization
LIFELINE HOME HEALTH CARE OF BOWLING GREEN, LLC
Active
Other names
Lifeline Health Care of Warren
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS GACHASSIN III (EXECUTIVE VICE PRESIDENT)
(337) 233-1307
Entity
Organization
Contact information
Practice address
165 NATCHEZ TRACE AVENUE, SUITE 206, BOWLING GREEN, KY 42103-7947
(270) 781-0702
(270) 781-8489
Mailing address
PO BOX 51266, LAFAYETTE, LA 70505-1266
(337) 233-1307
(337) 233-5764
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
150077
KY
261QR0400X
Rehabilitation Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000503487
ANTHEM BLUE CROSS BLUE SH
KY
05
—
41000100
—
KY
05
—
42000190
—
KY
05
—
45004447
—
KY
05
—
7100000480
—
KY
Enumeration date
07/10/2006
Last updated
01/13/2022
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