Organization
LIFEBOAT14LLC
Active
Organization
LIFEBOAT14LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETRUS HENDRIK VAN NIEKERK (OWNER)
(916) 521-8665
Entity
Organization
Contact information
Practice address
218 ESTATES DR, ROSEVILLE, CA 95678-2312
(916) 521-8665
Mailing address
133 PRIVETT CT, ROSEVILLE, CA 95747-6440
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
3MMX839
CA
Other
Enumeration date
08/09/2010
Last updated
08/09/2010
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