Provider Demographics
NPI:1063124006
Name:CAMBRIDGE CARE MEDICAL LYFT SERVICE
Entity type:Organization
Organization Name:CAMBRIDGE CARE MEDICAL LYFT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERICA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-206-4635
Mailing Address - Street 1:2907 VALES POINT DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-5003
Mailing Address - Country:US
Mailing Address - Phone:832-206-4635
Mailing Address - Fax:
Practice Address - Street 1:2907 VALES POINT DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-5003
Practice Address - Country:US
Practice Address - Phone:832-206-4635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)