Provider Demographics
NPI:1417221276
Name:ABSOLUTE MOBILITY LLC
Entity Type:Organization
Organization Name:ABSOLUTE MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAINWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-479-6872
Mailing Address - Street 1:9954 DILIGENCE LN
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-2927
Mailing Address - Country:US
Mailing Address - Phone:757-479-6872
Mailing Address - Fax:804-441-9043
Practice Address - Street 1:10514 BUCKLEY HALL RD
Practice Address - Street 2:UNIT 1
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109-0514
Practice Address - Country:US
Practice Address - Phone:757-479-6872
Practice Address - Fax:804-441-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-25
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA137524332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417221276Medicaid