Healthcare Provider Details

I. General information

NPI: 1952797276
Provider Name (Legal Business Name): LIFESTREAM TRANSPORTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 SHERMAN ST
WEST CHICAGO IL
60185-3343
US

IV. Provider business mailing address

PO BOX 225
WEST CHICAGO IL
60186-0225
US

V. Phone/Fax

Practice location:
  • Phone: 630-379-2686
  • Fax: 630-293-9161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: FELICIA N GILLS
Title or Position: PRESIDENT
Credential:
Phone: 630-379-2686