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General NPI Number Information
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NPI Number | 1710307368
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Entity Type | Organization
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Legal Business Name | LIFE CARE MEDICAL TRANSPORTATION LLC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 13 POTOMAC AVE FLOOR 2
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City | PATERSON
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State | NJ
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Zip | 07503-1601
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Country | US
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Telephone | 973-393-2776
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Fax | 732-283-4020
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Provider Business Mailing Address
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Address Line | 13 POTOMAC AVE FLOOR 2
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City | PATERSON
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State | NJ
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Zip | 07503-1601
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Country | US
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Telephone | 973-393-2776
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Fax | 732-283-4020
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | BRAHIM MEHDOUN
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Credential |
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Telephone | 973-393-2776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 100668
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License Number State | NJ
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