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General NPI Number Information
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NPI Number | 1952797276
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Entity Type | Organization
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Legal Business Name | LIFESTREAM TRANSPORTATION INC
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 675 SHERMAN ST
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City | WEST CHICAGO
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State | IL
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Zip | 60185-3343
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Country | US
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Telephone | 630-379-2686
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Fax | 630-293-9161
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Provider Business Mailing Address
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Address Line | PO BOX 225
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City | WEST CHICAGO
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State | IL
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Zip | 60186-0225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FELICIA N GILLS
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Credential |
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Telephone | 630-379-2686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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