Lifeline Home Health Care, Inc
Organization Active NPI Home Health Agency · Chickasha, OK
NPI 1982609962 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1982609962
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 7466 (OK)
- Legal business name
- LIFELINE HOME HEALTH CARE, INC
- Practice address
- 917 S 4TH St
Chickasha, OK 73018-4655 - Phone
- (405) 224-4891
- Fax
- (405) 224-4895
- NPI assigned
- Jun 16, 2005
- Organization subpart
- No
Authorized official
- Name
- Ms. Kelly D Jeanis, RN
- Title
- Administrator
- Phone
- (405) 224-4891
Affiliated clinicians 32
-
Kevin Anderson, D.O.
-
Sean Kelly Baker, CNP
-
Jay C Belt, DO
-
Delanie Berry, MS, RN, APRN, FNP-C
-
Robert J Gunderson, D.O.
-
Misti Heston, APRN, FNPC
-
Abby Marie Housman, D.O.
-
Latonia Queen Howard, FNP-BC
-
Brian Andrew Janek, PA-C
-
Ashley Johnson, FNP
-
Jacinda Marie Leadford, D.O.
-
Kylie Renee Lee, APRN, FNPC
-
Kyle V McGivern, DO
-
Jim G Melton, D.O.
-
Ahmad Musa, MD
-
Sibin Nair, MD
-
John D Randolph, M.D.
-
Steven S Sands, D.O.
Medicare Care Compare: Home health agency
- Listed as
- Lifeline Home Health Care, Inc
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Proprietary
- Certified
- Mar 27, 1996
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Home health agency certification: CCN 377524
- Legal name
- LIFELINE HOME HEALTH CARE, INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Mar 27, 1996
- Last certification
- Aug 5, 2021
- Ownership / control type
- Proprietary
- Organization structure
- Corporation · Proprietary
- Incorporated
- Feb 1, 1996 in OK
- Enrollment address
- 1701W Iowa Ave
Chickasha, OK 73018-2848
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Toye L Reynolds |
5% Or Greater Direct Ownership Interest | Jul 3, 2002 | 66.6% |
| Corporate Director | Jun 12, 2003 | ||
| Kelly D Nunn |
5% Or Greater Direct Ownership Interest | Sep 7, 2012 | 33.3% |
| Corporate Director | Mar 26, 1996 | ||
| W-2 Managing Employee | Mar 26, 1996 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090219000441 | OK | Part a Provider - Home Health Agency | 4486719713 | Practice locations: Chickasha, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 7466 | OK | Yes |
Addresses
Primary practice location
917 S 4TH St
Chickasha, OK 73018-4655
Mailing address
PO Box 1348
Chickasha, OK 73023-1348
Phone (405) 224-4891
Other providers in Chickasha, OK
- Kylie Renee Lee
- Pamela Jo Lee
- Summer Lee
- Bryan E Lehman
- Liberty Drug Inc
- Lifeline Hospice, Inc.
- Lifeline Private Duty Home Health Care, Inc.
- Kameron Lindsay
- Paula Sue Lister
- Logsdon Chiropractic, PLLC
All providers in Chickasha, OK · Home Health Agency in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.