Provider Demographics
NPI:1790570091
Name:GIFTED LIFE ON WHEELS
Entity type:Organization
Organization Name:GIFTED LIFE ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:SHAVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-843-4286
Mailing Address - Street 1:150 LAKE ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2468
Mailing Address - Country:US
Mailing Address - Phone:914-843-4296
Mailing Address - Fax:914-843-4296
Practice Address - Street 1:150 LAKE ST APT 1E
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2468
Practice Address - Country:US
Practice Address - Phone:914-843-4296
Practice Address - Fax:914-843-4296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty