Provider Demographics
NPI:1619994571
Name:COMMUNITY LIFETEAM, INC.
Entity Type:Organization
Organization Name:COMMUNITY LIFETEAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MESSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-848-4740
Mailing Address - Street 1:PO BOX 8700
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17105-8700
Mailing Address - Country:US
Mailing Address - Phone:717-848-4740
Mailing Address - Fax:717-848-4748
Practice Address - Street 1:1000 PAXTON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1644
Practice Address - Country:US
Practice Address - Phone:717-782-4699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007001520003Medicaid
PA0007001520006Medicaid