Provider Demographics
NPI:1144402934
Name:LIFECROSS, INC
Entity Type:Organization
Organization Name:LIFECROSS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:FISUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-828-3315
Mailing Address - Street 1:67 BUCK RD STE 139B-10
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1535
Mailing Address - Country:US
Mailing Address - Phone:215-828-3315
Mailing Address - Fax:
Practice Address - Street 1:67 BUCK RD STE 139B-10
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1535
Practice Address - Country:US
Practice Address - Phone:215-828-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance