Provider Demographics
NPI:1043439276
Name:LIFE GUARD INC.
Entity Type:Organization
Organization Name:LIFE GUARD INC.
Other - Org Name:PRESTON HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-329-0622
Mailing Address - Street 1:204 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1419
Mailing Address - Country:US
Mailing Address - Phone:304-329-0622
Mailing Address - Fax:304-329-0622
Practice Address - Street 1:204 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1419
Practice Address - Country:US
Practice Address - Phone:304-329-0622
Practice Address - Fax:304-329-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009478Medicaid
WV3810009478Medicaid