MEDICARE: LIFE ALLIANCE, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	13013	PA

General Provider Information

NPI Number	:	1457799413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE ALLIANCE, INCORPORATED

Provider Business Mailing Address
First Line	:	5440 WESTFORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1946 E WESTMORELAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-2522
Country	:	US
Telephone Number	:	215-617-2639
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/OFFICER
Name	:	HECTOR HERNANDEZ
Credential	:
Telephone Number	:	215-617-2639

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	06/11/2013

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Directions to “LIFE ALLIANCE, INCORPORATED ” Practice Location

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