Provider Demographics
NPI:1538682224
Name:TRUST LIFE LINE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:TRUST LIFE LINE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:TERRENCE
Authorized Official - Last Name:MACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-747-1927
Mailing Address - Street 1:38864 EQUESTRIAN S APT 49203
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-4925
Mailing Address - Country:US
Mailing Address - Phone:248-747-1927
Mailing Address - Fax:
Practice Address - Street 1:38864 EQUESTRIAN S APT 49203
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-4925
Practice Address - Country:US
Practice Address - Phone:248-747-1927
Practice Address - Fax:313-346-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)