Provider Demographics
NPI:1356683197
Name:LIFE LINE TRANSIT
Entity Type:Organization
Organization Name:LIFE LINE TRANSIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-399-8996
Mailing Address - Street 1:66 ROCK HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-8942
Mailing Address - Country:US
Mailing Address - Phone:215-399-8996
Mailing Address - Fax:
Practice Address - Street 1:66 ROCK HAVEN CT
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-8942
Practice Address - Country:US
Practice Address - Phone:215-399-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)