Provider Demographics
NPI:1417254897
Name:LIFE ALERT AMBULANCE INC
Entity Type:Organization
Organization Name:LIFE ALERT AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PERDIGAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-850-0590
Mailing Address - Street 1:2840 PINE ROAD
Mailing Address - Street 2:UNIT B1
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4242
Mailing Address - Country:US
Mailing Address - Phone:215-850-0590
Mailing Address - Fax:267-200-0501
Practice Address - Street 1:2840 PINE ROAD
Practice Address - Street 2:UNIT B1
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4242
Practice Address - Country:US
Practice Address - Phone:215-850-0590
Practice Address - Fax:267-200-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11016341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026036150001Medicaid
PA217819OtherMEDICARE PTAN