Provider Demographics
NPI:1578278370
Name:LIFE NEMT LLC
Entity Type:Organization
Organization Name:LIFE NEMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:ADOLPH
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-644-7014
Mailing Address - Street 1:2651 POYDRAS ST APT 2425
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7587
Mailing Address - Country:US
Mailing Address - Phone:504-405-0562
Mailing Address - Fax:
Practice Address - Street 1:2651 POYDRAS ST APT 2425
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7587
Practice Address - Country:US
Practice Address - Phone:504-405-0562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)