MEDICARE: LIFELINE E-TRANSPORT LLC

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1982438982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE E-TRANSPORT LLC

Provider Business Mailing Address
First Line	:	808 HARDY DR
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95605-2107
Country	:	US
Telephone Number	:	916-538-8407
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 HARDY DR
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95605-2107
Country	:	US
Telephone Number	:	916-538-8407
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JILDA AYING
Credential	:
Telephone Number	:	916-538-8407

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	08/30/2024

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