Healthcare Provider Details

I. General information

NPI: 1154168698
Provider Name (Legal Business Name): CEDAR VALLEY MOBILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 HAMMOND AVE
WATERLOO IA
50702-5618
US

IV. Provider business mailing address

3804 HAMMOND AVE
WATERLOO IA
50702-5618
US

V. Phone/Fax

Practice location:
  • Phone: 319-291-7210
  • Fax:
Mailing address:
  • Phone: 319-291-7210
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MORGAN
Title or Position: SUPERVISOR
Credential:
Phone: 319-291-7210