Provider Demographics
NPI:1447557178
Name:RAE MEDICAL
Entity Type:Organization
Organization Name:RAE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-715-4317
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-1343
Mailing Address - Country:US
Mailing Address - Phone:916-715-4317
Mailing Address - Fax:
Practice Address - Street 1:6454 PONY EXPRESS TRL
Practice Address - Street 2:SUITE 33
Practice Address - City:POLLOCK PINES
Practice Address - State:CA
Practice Address - Zip Code:95726-9652
Practice Address - Country:US
Practice Address - Phone:916-715-4317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA047113332B00000X, 332BC3200X, 332BN1400X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies