Healthcare Provider Details

I. General information

NPI: 1104459072
Provider Name (Legal Business Name): XYZ MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4246 E WOOD ST STE 460
PHOENIX AZ
85040-1985
US

IV. Provider business mailing address

4246 E WOOD ST STE 460
PHOENIX AZ
85040-1985
US

V. Phone/Fax

Practice location:
  • Phone: 480-828-1391
  • Fax: 800-238-6910
Mailing address:
  • Phone: 480-828-1391
  • Fax: 800-238-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN ADAM DECKER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 480-417-1860