Provider Demographics
NPI:1255562229
Name:ABILITY CENTER
Entity type:Organization
Organization Name:ABILITY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-541-0552
Mailing Address - Street 1:4797 RUFFNER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1519
Mailing Address - Country:US
Mailing Address - Phone:858-541-0552
Mailing Address - Fax:858-541-1941
Practice Address - Street 1:11600 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680
Practice Address - Country:US
Practice Address - Phone:714-890-8262
Practice Address - Fax:714-901-1492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABILITY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02121FMedicaid
NV1043770002Medicare NSC
CADME02121FMedicaid