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
101 BOWENS MILL RD, DOUGLAS, GA 31533-2254
(912) 384-2621
(912) 384-2599
Mailing address
1610 MADISON AVE, TIFTON, GA 31794-3756
(229) 382-1334
(229) 382-1350
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
303718836
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0942290006
MEDICARE
GA
Enumeration date
11/29/2006
Last updated
02/07/2012
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