Provider Demographics
NPI:1326168980
Name:HARBORSIDE CARE
Entity Type:Organization
Organization Name:HARBORSIDE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-636-2990
Mailing Address - Street 1:2807 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2815
Mailing Address - Country:US
Mailing Address - Phone:252-636-2990
Mailing Address - Fax:252-637-6011
Practice Address - Street 1:2807 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2815
Practice Address - Country:US
Practice Address - Phone:252-636-2990
Practice Address - Fax:252-637-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136F7Medicaid
NC89136F7Medicaid