Provider Demographics
NPI:1063615946
Name:LIFE SUPPORT AMBULANCE, INC
Entity type:Organization
Organization Name:LIFE SUPPORT AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-987-7783
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91043-0195
Mailing Address - Country:US
Mailing Address - Phone:818-987-7783
Mailing Address - Fax:
Practice Address - Street 1:5355 CARTWRIGHT AVE
Practice Address - Street 2:110
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3405
Practice Address - Country:US
Practice Address - Phone:818-987-7783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport