Provider Demographics
NPI:1215611587
Name:LIFE LINK TRANSPORT LLC
Entity type:Organization
Organization Name:LIFE LINK TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING AGENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULKADIR BWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULKADIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:778-685-1482
Mailing Address - Street 1:360 BLOOMFIELD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2700
Mailing Address - Country:US
Mailing Address - Phone:778-685-1482
Mailing Address - Fax:
Practice Address - Street 1:47 AVONWOOD RD APT 317
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2017
Practice Address - Country:US
Practice Address - Phone:778-685-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No342000000XTransportation ServicesTransportation Network Company
No344600000XTransportation ServicesTaxi
No347E00000XTransportation ServicesTransportation Broker