Provider Demographics
NPI:1356769103
Name:MOBILE HOME SPECIALIST
Entity type:Organization
Organization Name:MOBILE HOME SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-966-8495
Mailing Address - Street 1:PO BOX 9391
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-0391
Mailing Address - Country:US
Mailing Address - Phone:509-966-8495
Mailing Address - Fax:509-248-0648
Practice Address - Street 1:322 HORSESHOE BEND RD
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620-3604
Practice Address - Country:US
Practice Address - Phone:509-966-8495
Practice Address - Fax:509-248-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-30
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMOBILHS088MP171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty