MEDICARE: HARBORGROVE CARE&MOBILITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343800000X	Secured Medical Transport (VAN)
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1881541225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBORGROVE CARE&MOBILITY LLC

Provider Business Mailing Address
First Line	:	6023 S MANZANITA WAY
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-4062
Country	:	US
Telephone Number	:	208-206-0694
Fax Number	:

Provider Business Practice Location Address
First Line	:	6023 S MANZANITA WAY
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-4062
Country	:	US
Telephone Number	:	208-206-0694
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MUBAREK WESLEY HAWS
Credential	:
Telephone Number	:	208-206-0694

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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