Provider Demographics
NPI:1992026090
Name:SAFFRON'S SPECIALIZED MEDICAL, LLC
Entity Type:Organization
Organization Name:SAFFRON'S SPECIALIZED MEDICAL, LLC
Other - Org Name:SAFFRON'S SPECIALIZED MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAFFRON
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMF, MBA
Authorized Official - Phone:503-351-3974
Mailing Address - Street 1:101 WIKIUP DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1375
Mailing Address - Country:US
Mailing Address - Phone:503-351-3974
Mailing Address - Fax:707-526-0376
Practice Address - Street 1:101 WIKIUP DR
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1375
Practice Address - Country:US
Practice Address - Phone:707-526-0356
Practice Address - Fax:707-526-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-13
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201012610143332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6506730001Medicare NSC