Provider Demographics
NPI:1659709111
Name:LIFEGUARD AMBULANCE SERVICE OF LOUISIANA LLC
Entity Type:Organization
Organization Name:LIFEGUARD AMBULANCE SERVICE OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-949-1719
Mailing Address - Street 1:PO BOX 190007
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35219-0007
Mailing Address - Country:US
Mailing Address - Phone:205-380-2065
Mailing Address - Fax:205-380-2074
Practice Address - Street 1:955 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5745
Practice Address - Country:US
Practice Address - Phone:866-333-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEGUARD TRANSPORTATION SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance