Provider Demographics
NPI:1104459072
Name:XYZ MOBILITY LLC
Entity type:Organization
Organization Name:XYZ MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-417-1860
Mailing Address - Street 1:4246 E WOOD ST STE 460
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-1985
Mailing Address - Country:US
Mailing Address - Phone:480-828-1391
Mailing Address - Fax:800-238-6910
Practice Address - Street 1:4246 E WOOD ST STE 460
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-1985
Practice Address - Country:US
Practice Address - Phone:480-828-1391
Practice Address - Fax:800-238-6910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:XYZ MOBILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-19
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment