Provider Demographics
NPI:1760640726
Name:EASTSIDE MOBILITY, LLC
Entity Type:Organization
Organization Name:EASTSIDE MOBILITY, LLC
Other - Org Name:EASTSIDE MOBILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-241-0149
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-1325
Mailing Address - Country:US
Mailing Address - Phone:425-241-0149
Mailing Address - Fax:
Practice Address - Street 1:4921 370TH CT SE
Practice Address - Street 2:
Practice Address - City:FALL CITY
Practice Address - State:WA
Practice Address - Zip Code:98024-9721
Practice Address - Country:US
Practice Address - Phone:425-241-0149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6026137881332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0213921OtherWASHINGTOPN DEPARTMENT OF LABOR AND INDUSTRIES