Provider Demographics
NPI:1740911528
Name:ADVANCE LIFE CARE AMBULANCE LLC
Entity type:Organization
Organization Name:ADVANCE LIFE CARE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-702-1242
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0704
Mailing Address - Country:US
Mailing Address - Phone:787-702-1242
Mailing Address - Fax:
Practice Address - Street 1:CARR 162 KM 1.4 INT BO ASOMANTE
Practice Address - Street 2:SECTOR LAS ABEJAS
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-702-1242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport