Provider Demographics
NPI:1225455066
Name:REBEKAHS HAVEN INC
Entity Type:Organization
Organization Name:REBEKAHS HAVEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-355-6929
Mailing Address - Street 1:791 HAVERHILL RD N
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1342
Mailing Address - Country:US
Mailing Address - Phone:561-373-8656
Mailing Address - Fax:
Practice Address - Street 1:791 HAVERHILL RD N
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:FL
Practice Address - Zip Code:33415-1342
Practice Address - Country:US
Practice Address - Phone:561-373-8656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2074273291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory