Provider Demographics
NPI:1659695849
Name:GOLDEN STATE WHEELCHAIR EXPRESS
Entity Type:Organization
Organization Name:GOLDEN STATE WHEELCHAIR EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-333-5297
Mailing Address - Street 1:1321 HOWE AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3365
Mailing Address - Country:US
Mailing Address - Phone:916-333-5297
Mailing Address - Fax:916-286-7744
Practice Address - Street 1:1321 HOWE AVE STE 212
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3365
Practice Address - Country:US
Practice Address - Phone:916-333-5297
Practice Address - Fax:916-333-5298
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELAROSA ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)