Healthcare Provider Details

I. General information

NPI: 1215082110
Provider Name (Legal Business Name): LIFEFLEET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 MARKET ST
NORTH LIMA OH
44452-9775
US

IV. Provider business mailing address

PO BOX 390
NORTH LIMA OH
44452-0390
US

V. Phone/Fax

Practice location:
  • Phone: 330-549-9752
  • Fax: 330-549-9754
Mailing address:
  • Phone: 330-549-9752
  • Fax: 330-549-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateOH

VIII. Authorized Official

Name: DEBRA DIANE LOWERY
Title or Position: OWNER
Credential:
Phone: 330-549-9752