Organization
LIFE GUARD INC
Active
Other names
Life Guard Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONLUC TYRONE HARRIS (VICE PRESIDENT)
(304) 834-5370
Entity
Organization
Contact information
Practice address
1736 S PLEASANTS HWY, SAINT MARYS, WV 26170-4981
(304) 299-5063
(304) 299-5060
Mailing address
1736 S PLEASANTS HWY, SAINT MARYS, WV 26170-4981
(304) 299-5063
(304) 299-5060
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0147202000
—
WV
05
—
0232573
—
OH
Enumeration date
07/26/2006
Last updated
05/12/2025
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