Provider Demographics
NPI:1215402607
Name:HARBOR WELLNESS CENTER
Entity Type:Organization
Organization Name:HARBOR WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-931-3565
Mailing Address - Street 1:4575 VIA ROYALE # 201-203
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1043
Mailing Address - Country:US
Mailing Address - Phone:239-931-3565
Mailing Address - Fax:
Practice Address - Street 1:2915 COLONIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1009
Practice Address - Country:US
Practice Address - Phone:239-931-3565
Practice Address - Fax:855-861-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty