Healthcare Provider Details

I. General information

NPI: 1578562047
Provider Name (Legal Business Name): LIFESTAR AMBULANCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 LAGRANGE ST
TOLEDO OH
43608-2928
US

IV. Provider business mailing address

1402 LAGRANGE ST
TOLEDO OH
43608-2928
US

V. Phone/Fax

Practice location:
  • Phone: 419-245-6210
  • Fax: 419-245-7003
Mailing address:
  • Phone: 419-245-6210
  • Fax: 419-251-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number480049
License Number StateOH

VIII. Authorized Official

Name: MRS. CATHY NELSON
Title or Position: DIRECTOR
Credential:
Phone: 419-245-6210