Provider Demographics
NPI:1154942811
Name:SACVANS MOBILITY, INC.
Entity type:Organization
Organization Name:SACVANS MOBILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-381-8267
Mailing Address - Street 1:5821 FLORIN PERKINS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-1032
Mailing Address - Country:US
Mailing Address - Phone:916-381-8267
Mailing Address - Fax:916-381-1946
Practice Address - Street 1:5821 FLORIN PERKINS RD STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-1032
Practice Address - Country:US
Practice Address - Phone:916-381-8267
Practice Address - Fax:916-381-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA628706600OtherOWCP PROVIDER NUMBER