Provider Demographics
NPI:1457469462
Name:LIFECARE AMBULANCE
Entity Type:Organization
Organization Name:LIFECARE AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAGELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-969-8844
Mailing Address - Street 1:330 HAMBLIN AVE W
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-8430
Mailing Address - Country:US
Mailing Address - Phone:269-969-8844
Mailing Address - Fax:269-969-6096
Practice Address - Street 1:330 HAMBLIN AVE W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-2230
Practice Address - Country:US
Practice Address - Phone:269-969-8844
Practice Address - Fax:269-969-6096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1310063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590A300220OtherBLUE CROSS
MI183005468Medicaid