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General NPI Number Information
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NPI Number | 1093075350
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Entity Type | Organization
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Legal Business Name | LIFE TIME TRANSPORTATION LLC
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 2100 CLIFF RD E APT 217
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City | BURNSVILLE
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State | MN
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Zip | 55337-1309
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Country | US
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Telephone | 612-483-4439
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Fax |
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Provider Business Mailing Address
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Address Line | 3818 STINSON BLVD SUITE B
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City | ST ANTHONY
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State | MN
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Zip | 55421
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Country | US
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Telephone | 612-483-4439
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. FARHAN S HANDULLE
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Credential |
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Telephone | 612-483-4439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 48856120002
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License Number State |
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