Provider Demographics
NPI:1124266747
Name:MAXIMUM MOBILITY
Entity type:Organization
Organization Name:MAXIMUM MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:TROUPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-879-2677
Mailing Address - Street 1:2922 FULAM CT
Mailing Address - Street 2:
Mailing Address - City:RESCUE
Mailing Address - State:CA
Mailing Address - Zip Code:95672-9474
Mailing Address - Country:US
Mailing Address - Phone:916-879-2677
Mailing Address - Fax:
Practice Address - Street 1:2922 FULAM CT
Practice Address - Street 2:
Practice Address - City:RESCUE
Practice Address - State:CA
Practice Address - Zip Code:95672-9474
Practice Address - Country:US
Practice Address - Phone:916-879-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2004-033384332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies