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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