Organization
LIFE GUARD INC.
Active
Other names
Life Guard Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MATT SHIVELY (V.P.)
(304) 665-2346
Entity
Organization
Contact information
Practice address
JOHNSON STREET AND PINE CREEK ROAD, GRANTSVILLE, WV 26147
(304) 354-9103
(304) 354-9203
Mailing address
JOHNSON STREET AND PINE CREEK ROAD, GRANTSVILLE, WV 26147
(304) 354-9103
(304) 354-9203
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
NONE REQUIRED
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6202059000
—
WV
Enumeration date
12/11/2006
Last updated
06/04/2008
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