Provider Demographics
NPI:1053725903
Name:LIFESTREAM TRANSPORTATION LLC
Entity type:Organization
Organization Name:LIFESTREAM TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-764-8800
Mailing Address - Street 1:50 ELM ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-2648
Mailing Address - Country:US
Mailing Address - Phone:508-764-8800
Mailing Address - Fax:508-764-8802
Practice Address - Street 1:50 ELM ST
Practice Address - Street 2:UNIT B
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2648
Practice Address - Country:US
Practice Address - Phone:508-764-8800
Practice Address - Fax:508-764-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)