Provider Demographics
NPI:1417912924
Name:THE MOBILITY DEPOT, LLC
Entity Type:Organization
Organization Name:THE MOBILITY DEPOT, LLC
Other - Org Name:MOBILITY DEPOT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MENVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-215-2222
Mailing Address - Street 1:7931 ONE CALAIS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3403
Mailing Address - Country:US
Mailing Address - Phone:225-215-2222
Mailing Address - Fax:225-215-2248
Practice Address - Street 1:7931 ONE CALAIS AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3403
Practice Address - Country:US
Practice Address - Phone:225-215-2222
Practice Address - Fax:225-215-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology SupplierGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF8861OtherBLUECROSS BLUESHIELD
LA602016103OtherUS DEPT OF LABOR
LA12950OtherLA REHAB SERVICES
LA14384211Medicaid
LA=========OtherBESTCARE
LA=========OtherMSC
LA12950OtherLA REHAB SERVICES
LA=========OtherAMERICAN LIFECARE
LA=========OtherGALAXY HEALTH NETWORK
LA=========OtherTRICARE
LAF8861OtherBLUECROSS BLUESHIELD
LA=========OtherPHCS
LA=========OtherSTATE EMPLOYEES GROUP BEN
LA14384211Medicaid