Provider Demographics
NPI:1801035563
Name:CARIBBEAN LIFE SUPPORT TRANSPORT CORP
Entity Type:Organization
Organization Name:CARIBBEAN LIFE SUPPORT TRANSPORT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KERMITT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-903-1658
Mailing Address - Street 1:URB VISTA VERDE 714 CALLE 16
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-903-1658
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 110 KM 21.1
Practice Address - Street 2:BO. CEIBA BAJA
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-903-1658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 5603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport