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Organization
LIFE GUARD INC
Active
Organization
LIFE GUARD INC
Active
Other names
Wyoming Home Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATT SHIVELY (V.P.)
(304) 665-2346
Entity
Organization
Contact information
Practice address
CORNER OF BANK & MAIN ST., PINEVILLE, WV 24874
(304) 732-9270
(304) 732-9270
Mailing address
CORNER OF BANK & MAIN ST., PINEVILLE, WV 24874
(304) 732-9270
(304) 732-9270
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
NONE REQUIRED
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
NONE REQUIRED
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6204088000
—
WV
Enumeration date
12/14/2006
Last updated
09/11/2025
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