Provider Demographics
NPI:1528366606
Name:A LEG UP OF NORTHERN CA
Entity Type:Organization
Organization Name:A LEG UP OF NORTHERN CA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-523-4143
Mailing Address - Street 1:535 S SHORE CTR W
Mailing Address - Street 2:#121
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:535 S SHORE CTR W
Practice Address - Street 2:#121
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5725
Practice Address - Country:US
Practice Address - Phone:510-523-4143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies