Provider Demographics
NPI:1942912159
Name:JLIFE MED TRANSPORT, LLC.
Entity Type:Organization
Organization Name:JLIFE MED TRANSPORT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-320-9490
Mailing Address - Street 1:PO BOX 193596
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3596
Mailing Address - Country:US
Mailing Address - Phone:939-320-9490
Mailing Address - Fax:
Practice Address - Street 1:SR 176 KM 10.0 CUPEY ALTO
Practice Address - Street 2:COM EL MUDO SECTOR ZENON VIERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:939-320-9490
Practice Address - Fax:787-936-7428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)