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General NPI Number Information
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NPI Number | 1912068180
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Entity Type | Organization
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Legal Business Name | LIFE GUARD INC.
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 101 LOCUST AVE.
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City | SPENCER
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State | WV
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Zip | 25276
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Country | US
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Telephone | 304-927-6090
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Fax | 304-927-6090
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Provider Business Mailing Address
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Address Line | 101 LOCUST AVE.
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City | SPENCER
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State | WV
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Zip | 25276
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Country | US
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Telephone | 304-927-6090
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Fax | 304-927-6090
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JONLUC TYRONE HARRIS
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Credential |
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Telephone | 304-834-5370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | NONE REQUIRED
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License Number State |
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