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Organization
LIFE GUARD INC.
Active
Organization
LIFE GUARD INC.
Active
Other names
Roane Home Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONLUC TYRONE HARRIS (VICE PRESIDENT)
(304) 834-5370
Entity
Organization
Contact information
Practice address
101 LOCUST AVE., SPENCER, WV 25276
(304) 927-6090
(304) 927-6090
Mailing address
101 LOCUST AVE., SPENCER, WV 25276
(304) 927-6090
(304) 927-6090
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
NONE REQUIRED
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6202086000
—
WV
Enumeration date
12/12/2006
Last updated
05/12/2025
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