Provider Demographics
NPI:1871923573
Name:LIFELINE LOGISTICS LLC
Entity type:Organization
Organization Name:LIFELINE LOGISTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SOMIRUWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANNIARACHCHIGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-979-4020
Mailing Address - Street 1:2149 E GARVEY AVE N
Mailing Address - Street 2:SUITE#A-2
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1538
Mailing Address - Country:US
Mailing Address - Phone:909-979-4020
Mailing Address - Fax:909-524-4455
Practice Address - Street 1:2149 E GARVEY AVE N
Practice Address - Street 2:SUITE#A-2
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1538
Practice Address - Country:US
Practice Address - Phone:909-979-4020
Practice Address - Fax:909-524-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)