Provider Demographics
NPI:1427434547
Name:PURE LIFE TRANSPORTATION LLC
Entity type:Organization
Organization Name:PURE LIFE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZBIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-525-7597
Mailing Address - Street 1:6000 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2004
Mailing Address - Country:US
Mailing Address - Phone:313-525-7597
Mailing Address - Fax:
Practice Address - Street 1:6000 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2004
Practice Address - Country:US
Practice Address - Phone:313-525-7597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIZ110319048169343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)