Provider Demographics
NPI:1245904374
Name:LIFELINE AMBULANCE LLC
Entity type:Organization
Organization Name:LIFELINE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA COTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-777-1044
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0908
Mailing Address - Country:US
Mailing Address - Phone:787-657-4696
Mailing Address - Fax:
Practice Address - Street 1:URB LAS LOMAS Q3 CARR 21
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-657-4696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport