Provider Demographics
NPI:1114920774
Name:LIFELINE AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:LIFELINE AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPISARDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-645-8500
Mailing Address - Street 1:2593 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5812
Mailing Address - Country:US
Mailing Address - Phone:718-645-8500
Mailing Address - Fax:
Practice Address - Street 1:2593 W 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5812
Practice Address - Country:US
Practice Address - Phone:718-645-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72923416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01508709Medicaid
NY01508709Medicaid