Organization
LIFELINE HOME HEALTH CARE OF RUSSELLVILLE, LLC
Active
Other names
Lifeline Health Care of Logan
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD D. STELLY (PRESIDENT)
(337) 233-1307
Entity
Organization
Contact information
Practice address
1527 NASHVILLE ST, RUSSELLVILLE, KY 42276-8851
(270) 726-2408
(270) 726-7213
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
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000503509
ANTHEM BLUE CROSS BLUE SH
KY
05
—
7100003520
—
KY
05
—
7100003530
—
KY
05
—
7100005720
—
KY
Enumeration date
07/10/2006
Last updated
03/05/2014
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