Provider Demographics
NPI:1114091147
Name:LIFELINE EMS LLC
Entity Type:Organization
Organization Name:LIFELINE EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-462-8003
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:HOLLY GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72069-0592
Mailing Address - Country:US
Mailing Address - Phone:870-462-8003
Mailing Address - Fax:
Practice Address - Street 1:146 DR. HERD E. STONE
Practice Address - Street 2:
Practice Address - City:HOLLY GROVE
Practice Address - State:AR
Practice Address - Zip Code:72069
Practice Address - Country:US
Practice Address - Phone:870-462-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR319341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance