Provider Demographics
NPI:1598039497
Name:ACCESS WHEELCHAIR REPAIR, LLC
Entity Type:Organization
Organization Name:ACCESS WHEELCHAIR REPAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MHRM, BS
Authorized Official - Phone:770-609-6187
Mailing Address - Street 1:283 SWANSON DR
Mailing Address - Street 2:STE 103
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8547
Mailing Address - Country:US
Mailing Address - Phone:770-609-6187
Mailing Address - Fax:770-558-2077
Practice Address - Street 1:283 SWANSON DR
Practice Address - Street 2:STE 103
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8547
Practice Address - Country:US
Practice Address - Phone:770-609-6187
Practice Address - Fax:770-558-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19125027332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies