Provider Demographics
NPI:1154886166
Name:LIFEWEST NORTHERN CALIFORNIA
Entity type:Organization
Organization Name:LIFEWEST NORTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-766-2404
Mailing Address - Street 1:PO BOX 2930
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-0930
Mailing Address - Country:US
Mailing Address - Phone:800-811-4045
Mailing Address - Fax:
Practice Address - Street 1:2180 S MCDOWELL BOULEVARD EXT STE B
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6975
Practice Address - Country:US
Practice Address - Phone:707-755-5060
Practice Address - Fax:707-755-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport