NPIMap

Organization Active NPI

Lifeline Home Health Care, Inc

  • Home Health Agency
  • Chickasha, OK
National Provider Identifier
1982609962
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
7466 Issued in 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
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kelly D Jeanis, RN
Title
Administrator
Phone
(405) 224-4891

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 7466 OK Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090219000441 OK Part A Provider - Home Health Agency 4486719713 Practice locations: Chickasha, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982609962. Details of each certification follow.

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
CorporationProprietary
Incorporated
Feb 1, 1996 in OK
Enrollment address
1701W Iowa Ave
Chickasha, OK 73018-2848

Care Compare: Home health agency

Medicare Care Compare
Listed as
Lifeline Home Health Care, IncCCN 377524 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Mar 27, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

917 S 4th St
Chickasha, OK 73018
Phone (405) 224-4891

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Toye L Reynolds Individual 5% Or Greater Direct Ownership Interest Jul 3, 2002 66.6%
Corporate Director Jun 12, 2003
Kelly D Nunn Individual 5% Or Greater Direct Ownership Interest Sep 7, 2012 33.3%
Corporate Director Mar 26, 1996
W-2 Managing Employee Mar 26, 1996

Practitioners & affiliated clinicians

Affiliated clinicians 32

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982609962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1348",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730231348",
            "telephone_number": "405-224-4891",
            "fax_number": "405-224-4895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 S 4TH ST",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730184655",
            "telephone_number": "405-224-4891",
            "fax_number": "405-224-4895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE HOME HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JEANIS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "405-224-4891",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OK",
            "license": "7466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chickasha, OK

Sources for this page

Verify at the official NPI Registry.