Provider Demographics
NPI:1285621797
Name:LIFESTAR RESPONSE OF ALABAMA, INC.
Entity type:Organization
Organization Name:LIFESTAR RESPONSE OF ALABAMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-868-6668
Mailing Address - Street 1:PO BOX 530481
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0481
Mailing Address - Country:US
Mailing Address - Phone:888-876-2100
Mailing Address - Fax:888-790-0688
Practice Address - Street 1:1150 PANAMA ST. SOUTH
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-2704
Practice Address - Country:US
Practice Address - Phone:800-449-4911
Practice Address - Fax:334-262-2538
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FALCK EMS CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0030743416L0300X
AL10393416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200051103Medicaid
AL200051103Medicaid