Basic Information
| Provider Information | |||||||||
| NPI: | 1154801314 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARBOR HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 735 ATTUCKS LN | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026011867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087785444 | ||||||||
| FaxNumber: | 5087788747 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 HARRY KEMP WAY | ||||||||
| Address2: | |||||||||
| City: | PROVINCETOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026571618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087785440 | ||||||||
| FaxNumber: | 5087788747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2018 | ||||||||
| LastUpdateDate: | 04/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6175332350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 4O3A | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.