Provider Demographics
NPI:1275618035
Name:LIFEQUEST LLC
Entity Type:Organization
Organization Name:LIFEQUEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-798-6540
Mailing Address - Street 1:4719 PALMETTO RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-9712
Mailing Address - Country:US
Mailing Address - Phone:318-965-2740
Mailing Address - Fax:318-965-0769
Practice Address - Street 1:4719 PALMETTO RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-9712
Practice Address - Country:US
Practice Address - Phone:318-965-2740
Practice Address - Fax:318-965-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1628905Medicaid
LA5388050001Medicare ID - Type Unspecified