Provider Demographics
NPI:1932608130
Name:LIFE ON WHEELS LLC
Entity type:Organization
Organization Name:LIFE ON WHEELS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:707-825-6515
Mailing Address - Street 1:550 S G ST STE 29
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-2601
Mailing Address - Country:US
Mailing Address - Phone:707-825-6515
Mailing Address - Fax:707-825-6915
Practice Address - Street 1:550 S G ST STE 29
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-2601
Practice Address - Country:US
Practice Address - Phone:707-825-6515
Practice Address - Fax:707-825-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98455332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment