Healthcare Provider Details

I. General information

NPI: 1295348761
Provider Name (Legal Business Name): PENN STATE HEALTH LIFE LION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N 21ST ST STE 101
CAMP HILL PA
17011-2202
US

IV. Provider business mailing address

500 UNIVERSITY DRIVE MAIL CODE CA210
HERSHEY PA
17033
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-2108
  • Fax: 717-972-4753
Mailing address:
  • Phone: 717-531-1159
  • Fax: 717-531-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN M MASSINI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 717-531-6614