MEDICARE: LIFESTREAM TRANSPORTATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1952797276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTREAM TRANSPORTATION INC

Provider Business Mailing Address
First Line	:	PO BOX 225
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60186-0225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 SHERMAN ST
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3343
Country	:	US
Telephone Number	:	630-379-2686
Fax Number	:	630-293-9161

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FELICIA N GILLS
Credential	:
Telephone Number	:	630-379-2686

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	04/14/2015

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Directions to “LIFESTREAM TRANSPORTATION INC ” Practice Location

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