Provider Demographics
NPI:1487332714
Name:MCGRUDER'S FRANCHISE
Entity type:Organization
Organization Name:MCGRUDER'S FRANCHISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRUDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:916-370-6372
Mailing Address - Street 1:5767 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5767 MONTCLAIR AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6820
Practice Address - Country:US
Practice Address - Phone:916-370-6372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)