Provider Demographics
NPI:1962734376
Name:LIFE TOUCH TRANSPORT, LLC
Entity type:Organization
Organization Name:LIFE TOUCH TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ROXANNE
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-925-7420
Mailing Address - Street 1:1802 BIG BOTTOM HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-8201
Mailing Address - Country:US
Mailing Address - Phone:304-925-7420
Mailing Address - Fax:
Practice Address - Street 1:1802 BIG BOTTOM HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-8201
Practice Address - Country:US
Practice Address - Phone:304-925-7420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2235-2951343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)