Provider Demographics
NPI:1184690372
Name:LEBANON LIFESAVING CREW INCORPORATED
Entity Type:Organization
Organization Name:LEBANON LIFESAVING CREW INCORPORATED
Other - Org Name:LEBANON LIFE SAVING CREW INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-889-2674
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-8413
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:60 SOUTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4412
Practice Address - Country:US
Practice Address - Phone:276-889-2674
Practice Address - Fax:276-889-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184690372Medicaid
VA590015121OtherRAILROAD MEDICARE