Provider Demographics
NPI:1902673122
Name:LION'S DISABILITY TRANSPORT SERVICE
Entity Type:Organization
Organization Name:LION'S DISABILITY TRANSPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-274-7850
Mailing Address - Street 1:2617 E LINCOLNWAY STE J
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5666
Mailing Address - Country:US
Mailing Address - Phone:307-514-4363
Mailing Address - Fax:307-514-4363
Practice Address - Street 1:2617 E LINCOLNWAY STE J
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5666
Practice Address - Country:US
Practice Address - Phone:307-514-4363
Practice Address - Fax:307-514-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)