Provider Demographics
NPI:1235550377
Name:NORTHCOAST MOBILITY
Entity Type:Organization
Organization Name:NORTHCOAST MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-457-1664
Mailing Address - Street 1:1281 ANDERSEN DR STE F
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5335
Mailing Address - Country:US
Mailing Address - Phone:415-457-1664
Mailing Address - Fax:415-457-6206
Practice Address - Street 1:1281 ANDERSEN DR STE F
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5335
Practice Address - Country:US
Practice Address - Phone:415-457-1664
Practice Address - Fax:415-457-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies