Provider Demographics
NPI:1689199226
Name:MADRAG LLC
Entity Type:Organization
Organization Name:MADRAG LLC
Other - Org Name:101 MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:BILL
Authorized Official - Last Name:RAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-437-4097
Mailing Address - Street 1:200 BETHLEHEM DR BLDG C-145
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-9771
Mailing Address - Country:US
Mailing Address - Phone:610-913-0060
Mailing Address - Fax:610-913-0065
Practice Address - Street 1:200 BETHLEHEM DR BLDG C-145
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-9771
Practice Address - Country:US
Practice Address - Phone:610-913-0060
Practice Address - Fax:610-913-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171WH0202X, 332BC3200X
PA6000007663332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033408400002Medicaid