Basic Information
| Provider Information | |||||||||
| NPI: | 1386149482 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARBOR HOMES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HARBOR CARE HEALTH AND WELLNESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 NORTHEASTERN BLVD | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030623128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038823616 | ||||||||
| FaxNumber: | 6035957414 | ||||||||
| Practice Location | |||||||||
| Address1: | 10-12 AMHERST ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030640306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038217788 | ||||||||
| FaxNumber: | 6038215620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2018 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | TIMMINS | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING/ CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 6038823616 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HARBOR HOMES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.