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
220 S 14TH ST, FERNANDINA BEACH, FL 32034-3216
(904) 321-0242
(904) 321-0930
Mailing address
1610 MADISON AVE, TIFTON, GA 31794-3756
(904) 321-0242
(904) 321-0930
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
55-8013641105-5
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0942290004
MEDICARE
FL
Enumeration date
11/29/2006
Last updated
02/09/2012
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