Provider Demographics
NPI:1568151538
Name:HAVEL, SAMANTHA JOE
Entity Type:Individual
Prefix:PROF
First Name:SAMANTHA
Middle Name:JOE
Last Name:HAVEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 MECHANIC AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-1405
Mailing Address - Country:US
Mailing Address - Phone:330-389-3774
Mailing Address - Fax:
Practice Address - Street 1:1027 MECHANIC AVE
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-1405
Practice Address - Country:US
Practice Address - Phone:330-389-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X, 347C00000X, 172A00000X, 261QA0600X
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No172A00000XOther Service ProvidersDriver
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care