Basic Information
| Provider Information | |||||||||
| NPI: | 1225576390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR HOMES, INC. | ||||||||
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| OtherOrganizationName: | HARBOR CARE HEALTH AND WELLNESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 NORTHEASTERN BLVD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030623128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038823616 | ||||||||
| FaxNumber: | 6035957414 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038823616 | ||||||||
| FaxNumber: | 6035957414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2017 | ||||||||
| LastUpdateDate: | 04/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | TIMMINS | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING/CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 6038166357 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 385H00000X | N | Respite Care Facility | Respite Care | 101Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 163W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 04166 | 01 | NH | HARBOR CARE HEALTH AND WELLNESS CTR- PEGGY AND DAVID GILMOUR RESPITE CENTER | OTHER |