Healthcare Provider Details

I. General information

NPI: 1962002279
Provider Name (Legal Business Name): LIFE SERVICES &TRANSPORTATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 MOUNTAIN ROAD
HALIFAX VA
24558
US

IV. Provider business mailing address

1100 BILL TUCK HWY
SOUTH BOSTON VA
24592-7138
US

V. Phone/Fax

Practice location:
  • Phone: 434-272-9342
  • Fax:
Mailing address:
  • Phone: 434-272-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TYRONZA COLEMAN
Title or Position: PRESIDENT
Credential:
Phone: 434-272-9342