Provider Demographics
NPI:1255002903
Name:LYFE RIDE MEDICAL TRANSPORTATION, LLC
Entity type:Organization
Organization Name:LYFE RIDE MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSELIO GILES
Authorized Official - Middle Name:LEGASPI
Authorized Official - Last Name:IMPERIAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:559-392-5455
Mailing Address - Street 1:2838 N HANALEI AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93737-0020
Mailing Address - Country:US
Mailing Address - Phone:559-392-5455
Mailing Address - Fax:
Practice Address - Street 1:2838 N HANALEI AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93737-0020
Practice Address - Country:US
Practice Address - Phone:559-392-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)