Provider Demographics
NPI:1528725470
Name:PEACE MOBILITY
Entity type:Organization
Organization Name:PEACE MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:EBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-214-6962
Mailing Address - Street 1:921 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8119
Mailing Address - Country:US
Mailing Address - Phone:651-214-6962
Mailing Address - Fax:
Practice Address - Street 1:921 LINDSEY LN
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8119
Practice Address - Country:US
Practice Address - Phone:651-214-6962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-25
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN476233521Medicaid