1629281779 NPI number — ACTIVE MOBILITY CENTER INC.

Table of content: (NPI 1629281779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629281779 NPI number — ACTIVE MOBILITY CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTIVE MOBILITY CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629281779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14330 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92395-4212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-962-1050
Provider Business Mailing Address Fax Number:
760-962-1060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14330 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92395-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-962-1050
Provider Business Practice Location Address Fax Number:
760-962-1060
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHALIKAR
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
ISA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-962-1050

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  138362 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 486756900 . This is a "U.S. DEPT. OF LABOR-FECA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DME 03297F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".