Provider Demographics
NPI:1164025045
Name:LIFECARE AMBULANCE OF MISSISSIPPI LLC
Entity type:Organization
Organization Name:LIFECARE AMBULANCE OF MISSISSIPPI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERLIHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-933-9348
Mailing Address - Street 1:3737 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-4008
Mailing Address - Country:US
Mailing Address - Phone:847-933-9348
Mailing Address - Fax:
Practice Address - Street 1:10060 HIGHWAY 178
Practice Address - Street 2:UNIT 600
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3271
Practice Address - Country:US
Practice Address - Phone:901-372-0200
Practice Address - Fax:901-372-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance