Healthcare Provider Details

I. General information

NPI: 1477132009
Provider Name (Legal Business Name): LYFE ON WHEELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/02/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 RAPPAHANNOCK DR
WHITE STONE VA
22578-2658
US

IV. Provider business mailing address

PO BOX 171
WHITE STONE VA
22578-0171
US

V. Phone/Fax

Practice location:
  • Phone: 804-436-7603
  • Fax:
Mailing address:
  • Phone: 804-436-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: VONNIQUE OWENS
Title or Position: OWNER
Credential:
Phone: 804-436-7603