Provider Demographics
NPI:1477755965
Name:MODERN MOBILITY
Entity Type:Organization
Organization Name:MODERN MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOULDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:302-376-6721
Mailing Address - Street 1:16 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1061
Mailing Address - Country:US
Mailing Address - Phone:302-378-5433
Mailing Address - Fax:303-378-5433
Practice Address - Street 1:16 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1061
Practice Address - Country:US
Practice Address - Phone:302-378-5433
Practice Address - Fax:303-378-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2007217822332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies