Provider Demographics
NPI:1619003811
Name:GRAND WHEELCHAIR & MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:GRAND WHEELCHAIR & MEDICAL SUPPLY INC
Other - Org Name:ALL WHEELCHAIR & MOBILITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALIZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-353-1999
Mailing Address - Street 1:41917 ALBRAE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3121
Mailing Address - Country:US
Mailing Address - Phone:510-353-1999
Mailing Address - Fax:510-353-1991
Practice Address - Street 1:41917 ALBRAE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-3121
Practice Address - Country:US
Practice Address - Phone:510-353-1999
Practice Address - Fax:510-353-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADME03310F332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03310FMedicaid
CADME03310FMedicaid