Provider Demographics
NPI:1164164992
Name:HAVEN MOBILITY
Entity Type:Organization
Organization Name:HAVEN MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIBAYIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-755-3653
Mailing Address - Street 1:3136 STATE ROUTE 207 STE 202
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2234
Mailing Address - Country:US
Mailing Address - Phone:845-202-0554
Mailing Address - Fax:845-615-9189
Practice Address - Street 1:3136 STATE ROUTE 207 STE 202
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-2234
Practice Address - Country:US
Practice Address - Phone:845-202-0554
Practice Address - Fax:845-615-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy