Provider Demographics
NPI:1952350043
Name:PHYLLIS BORGARDT & ASSC., INC.
Entity type:Organization
Organization Name:PHYLLIS BORGARDT & ASSC., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORGARDT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR-L
Authorized Official - Phone:805-489-9335
Mailing Address - Street 1:191 S OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2265
Mailing Address - Country:US
Mailing Address - Phone:805-489-9335
Mailing Address - Fax:805-489-9327
Practice Address - Street 1:191 S OAK PARK BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2265
Practice Address - Country:US
Practice Address - Phone:805-489-9335
Practice Address - Fax:805-489-9327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03230FMedicaid
CA43293OtherHOME MEDICAL DEVICE
CADME03230FMedicaid
CA43293OtherHOME MEDICAL DEVICE