Provider Demographics
NPI:1972867190
Name:HAVEN TRANSPORTATION SERVICE LLC
Entity Type:Organization
Organization Name:HAVEN TRANSPORTATION SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUNDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-338-4126
Mailing Address - Street 1:190 S BELVOIR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2345
Mailing Address - Country:US
Mailing Address - Phone:216-338-4126
Mailing Address - Fax:216-965-0411
Practice Address - Street 1:17822 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1220
Practice Address - Country:US
Practice Address - Phone:216-338-4126
Practice Address - Fax:216-965-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189135343900000X, 347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH189135OtherOHIO MEDICAL TRANSPORTATION BOARD SERVICE NUMBER