Healthcare Provider Details

I. General information

NPI: 1316100431
Provider Name (Legal Business Name): DLW,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8250 CALVINE RD STE 161
SACRAMENTO CA
95828-9313
US

IV. Provider business mailing address

8250 CALVINE RD STE 161
SACRAMENTO CA
95828-9313
US

V. Phone/Fax

Practice location:
  • Phone: 916-753-5999
  • Fax:
Mailing address:
  • Phone: 916-753-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA

VIII. Authorized Official

Name: DELANIOUS LEON WARD
Title or Position: OWNER
Credential:
Phone: 916-753-5999