Provider Demographics
NPI:1619225943
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:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VAIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-847-2020
Mailing Address - Street 1:6500 NE HALSEY BLDG B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5092
Mailing Address - Country:US
Mailing Address - Phone:503-847-2020
Mailing Address - Fax:888-624-7890
Practice Address - Street 1:271 SALEM ST
Practice Address - Street 2:UNIT C&D
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2004
Practice Address - Country:US
Practice Address - Phone:781-281-2733
Practice Address - Fax:888-440-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5051890003Medicare PIN