Provider Demographics
NPI:1366779035
Name:LIFELINE RGV LLC
Entity type:Organization
Organization Name:LIFELINE RGV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEYDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-683-8181
Mailing Address - Street 1:4601 BUDDY OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4827
Mailing Address - Country:US
Mailing Address - Phone:956-683-8181
Mailing Address - Fax:956-683-8191
Practice Address - Street 1:4601 BUDDY OWENS AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4827
Practice Address - Country:US
Practice Address - Phone:956-683-8181
Practice Address - Fax:956-683-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000355341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210568601Medicaid
TXAMB944Medicare PIN