Provider Demographics
NPI:1558741173
Name:KEEN MOBILITY COMPANY
Entity Type:Organization
Organization Name:KEEN MOBILITY COMPANY
Other - Org Name:KEEN HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-285-9090
Mailing Address - Street 1:5457 SW CANYON CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2401
Mailing Address - Country:US
Mailing Address - Phone:503-847-2020
Mailing Address - Fax:888-624-7890
Practice Address - Street 1:9510 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7413
Practice Address - Country:US
Practice Address - Phone:503-847-2020
Practice Address - Fax:888-624-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR667119332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9055716Medicaid
AK1571193Medicaid
OR233141Medicaid
WA9055716Medicaid