Provider Demographics
NPI:1518058197
Name:SIERRA LIFESTAR INC.,
Entity Type:Organization
Organization Name:SIERRA LIFESTAR INC.,
Other - Org Name:LIFESTAR AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-688-2550
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93275-1101
Mailing Address - Country:US
Mailing Address - Phone:559-688-2550
Mailing Address - Fax:559-688-2714
Practice Address - Street 1:234 N M ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4139
Practice Address - Country:US
Practice Address - Phone:559-688-2550
Practice Address - Fax:559-688-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMB06/0053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00775FMedicaid
CAMTE00775FMedicaid
CA=========OtherFEDERAL TAX ID