Provider Demographics
NPI:1700869245
Name:UNGORAS INC.
Entity Type:Organization
Organization Name:UNGORAS INC.
Other - Org Name:REHAB MOBILITY SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-523-0516
Mailing Address - Street 1:1319 CENTRAL AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4700
Mailing Address - Country:US
Mailing Address - Phone:707-523-0516
Mailing Address - Fax:415-276-6350
Practice Address - Street 1:1319 CENTRAL AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4700
Practice Address - Country:US
Practice Address - Phone:707-523-0516
Practice Address - Fax:415-276-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52732332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00265FMedicaid
CA0302240001Medicare NSC
0302240001Medicare ID - Type Unspecified