Provider Demographics
NPI:1417320474
Name:FOWLER ENTERPRISE LLC
Entity Type:Organization
Organization Name:FOWLER ENTERPRISE LLC
Other - Org Name:ELK GROVE COOP CAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAVELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-424-7078
Mailing Address - Street 1:5601 66TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2648
Mailing Address - Country:US
Mailing Address - Phone:916-670-7078
Mailing Address - Fax:916-421-4042
Practice Address - Street 1:5601 66TH AVE STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2648
Practice Address - Country:US
Practice Address - Phone:916-670-7078
Practice Address - Fax:916-421-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)