Provider Demographics
NPI:1124554837
Name:HARBORVIEW WAYCROSS, LLC
Entity Type:Organization
Organization Name:HARBORVIEW WAYCROSS, LLC
Other - Org Name:HARBORVIEW PIERCE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-523-4822
Mailing Address - Street 1:221 E CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-1545
Mailing Address - Country:US
Mailing Address - Phone:912-449-6631
Mailing Address - Fax:912-449-6631
Practice Address - Street 1:221 E CARTER AVE
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1545
Practice Address - Country:US
Practice Address - Phone:912-449-6631
Practice Address - Fax:912-449-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115265Medicare Oscar/Certification