Provider Demographics
NPI:1356830905
Name:LIFT RESPONDERS
Entity Type:Organization
Organization Name:LIFT RESPONDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:JEREL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-902-3414
Mailing Address - Street 1:8108 BURGWYN LN
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-8960
Mailing Address - Country:US
Mailing Address - Phone:919-902-3414
Mailing Address - Fax:
Practice Address - Street 1:8108 BURGWYN LN
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592
Practice Address - Country:US
Practice Address - Phone:919-902-3414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty