Provider Demographics
NPI:1356678015
Name:GRAY CONSTRUCTION VAND SECURMENT SERVICES - EZ LIFT ACCESSIBILITY PROD
Entity type:Organization
Organization Name:GRAY CONSTRUCTION VAND SECURMENT SERVICES - EZ LIFT ACCESSIBILITY PROD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-353-4848
Mailing Address - Street 1:1102 MORMON ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2416
Mailing Address - Country:US
Mailing Address - Phone:916-353-4848
Mailing Address - Fax:916-353-4848
Practice Address - Street 1:8136 # A JUNIPERO STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828
Practice Address - Country:US
Practice Address - Phone:916-381-6901
Practice Address - Fax:916-353-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies