Provider Demographics
NPI:1730667809
Name:HABANA 1000 SERVICES INC
Entity Type:Organization
Organization Name:HABANA 1000 SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:JACOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-728-9077
Mailing Address - Street 1:11825 SW 208TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7008
Mailing Address - Country:US
Mailing Address - Phone:305-728-9077
Mailing Address - Fax:
Practice Address - Street 1:11825 SW 208TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7008
Practice Address - Country:US
Practice Address - Phone:305-728-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)