Provider Demographics
NPI:1669474029
Name:MOBILE LIFE SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:MOBILE LIFE SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CUSTOMER SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTENOGRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-561-5698
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12551
Mailing Address - Country:US
Mailing Address - Phone:845-562-4368
Mailing Address - Fax:845-565-8019
Practice Address - Street 1:3188 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553
Practice Address - Country:US
Practice Address - Phone:845-562-4368
Practice Address - Fax:845-565-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341600000X341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00674584Medicaid
NY00674584Medicaid