Basic Information
| Provider Information | |||||||||
| NPI: | 1609223940 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BANE HARBOR HOUSE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HARBOR HOUSE ADULT DAY HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 ACCORD PARK DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818786700 | ||||||||
| FaxNumber: | 7818789807 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 CONDITO RD | ||||||||
| Address2: | |||||||||
| City: | HINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020431746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817494774 | ||||||||
| FaxNumber: | 4817496881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2016 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | BANE | ||||||||
| AuthorizedOfficialFirstName: | HARRISON | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7878786700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No ID Information.