Provider Demographics
NPI:1982902284
Name:RAMBOMOBILE DECKS &FENCE
Entity Type:Organization
Organization Name:RAMBOMOBILE DECKS &FENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-204-4463
Mailing Address - Street 1:1624 HEAD-OF-RIVER RD.
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322
Mailing Address - Country:US
Mailing Address - Phone:757-204-4463
Mailing Address - Fax:
Practice Address - Street 1:1624 HEAD-OF-RIVER RD.
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322
Practice Address - Country:US
Practice Address - Phone:757-204-4463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1106464332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies