Provider Demographics
NPI:1881334324
Name:LSA INDUSTRIES LLC
Entity type:Organization
Organization Name:LSA INDUSTRIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEBOAH ACHEAMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-364-7908
Mailing Address - Street 1:2302 FENCELINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-8931
Mailing Address - Country:US
Mailing Address - Phone:414-364-7908
Mailing Address - Fax:
Practice Address - Street 1:2302 FENCELINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-8931
Practice Address - Country:US
Practice Address - Phone:414-364-7908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100196551Medicaid