Provider Demographics
NPI:1932838042
Name:ROGUE VALLEY MOBILITY LLC
Entity Type:Organization
Organization Name:ROGUE VALLEY MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRAD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-660-3609
Mailing Address - Street 1:1667 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5367
Mailing Address - Country:US
Mailing Address - Phone:541-660-3609
Mailing Address - Fax:
Practice Address - Street 1:1667 VIRGINIA LN
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5367
Practice Address - Country:US
Practice Address - Phone:541-660-3609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies