Provider Demographics
NPI:1992728208
Name:LIFE GUARD INC
Entity type:Organization
Organization Name:LIFE GUARD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOESPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-665-2346
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:401 RIVERVIEW DR
Mailing Address - City:BELMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26134
Mailing Address - Country:US
Mailing Address - Phone:304-665-2346
Mailing Address - Fax:304-665-9402
Practice Address - Street 1:208 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:WV
Practice Address - Zip Code:26134
Practice Address - Country:US
Practice Address - Phone:604-665-2346
Practice Address - Fax:304-665-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0147202000Medicaid
OH0232573Medicaid
0235060001Medicare ID - Type Unspecified