Provider Demographics
NPI:1831223486
Name:LIFE GUARD INTERNATIONAL, INC.
Entity type:Organization
Organization Name:LIFE GUARD INTERNATIONAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-495-1220
Mailing Address - Street 1:FILE 56141
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-6141
Mailing Address - Country:US
Mailing Address - Phone:702-740-5952
Mailing Address - Fax:702-740-5951
Practice Address - Street 1:145 E RENO AVE
Practice Address - Street 2:SUITE E7
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-1114
Practice Address - Country:US
Practice Address - Phone:702-740-5952
Practice Address - Fax:702-740-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
NV3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003202175Medicaid
37046Medicare ID - Type UnspecifiedAMBULANCE, AIR