Provider Demographics
NPI:1457539611
Name:HAPPY TRAILS ELECTRIC VEHICLE SERVICE
Entity Type:Organization
Organization Name:HAPPY TRAILS ELECTRIC VEHICLE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-891-9863
Mailing Address - Street 1:817 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3503
Mailing Address - Country:US
Mailing Address - Phone:419-891-0863
Mailing Address - Fax:419-893-1404
Practice Address - Street 1:817 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3503
Practice Address - Country:US
Practice Address - Phone:419-891-0863
Practice Address - Fax:419-893-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0976118Medicaid
OH0976118Medicaid