Provider Demographics
NPI:1598083321
Name:LIFERITE EMS INC
Entity Type:Organization
Organization Name:LIFERITE EMS INC
Other - Org Name:LIFERITE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKEJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-881-2668
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-0641
Mailing Address - Country:US
Mailing Address - Phone:832-881-2668
Mailing Address - Fax:
Practice Address - Street 1:7400 HARWIN DR
Practice Address - Street 2:SUITE 317
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2014
Practice Address - Country:US
Practice Address - Phone:832-881-2668
Practice Address - Fax:281-238-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10004273416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214689601Medicaid
TXAMB1015OtherMEDICARE