Provider Demographics
NPI:1922014760
Name:LIFELINK HOME HEALTH CARE SERVICES, INC.
Entity type:Organization
Organization Name:LIFELINK HOME HEALTH CARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BHAVANI KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KODEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-515-6789
Mailing Address - Street 1:30600 NORTHWESTERN HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3171
Mailing Address - Country:US
Mailing Address - Phone:248-702-0890
Mailing Address - Fax:248-783-6789
Practice Address - Street 1:30600 NORTHWESTERN HWY STE 210
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3171
Practice Address - Country:US
Practice Address - Phone:248-702-0890
Practice Address - Fax:248-783-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MI237506251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237506Medicare Oscar/Certification