Provider Demographics
NPI:1750528881
Name:UNKL ALS MOBILITY CENTER
Entity type:Organization
Organization Name:UNKL ALS MOBILITY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:W.
Authorized Official - Middle Name:AL
Authorized Official - Last Name:HEUSCHKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-704-8655
Mailing Address - Street 1:PO BOX 21595
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86439-1595
Mailing Address - Country:US
Mailing Address - Phone:928-704-8655
Mailing Address - Fax:928-704-9106
Practice Address - Street 1:540 HANCOCK RD. (SHIP TO ONLY)
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-704-8655
Practice Address - Fax:928-704-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment