Provider Demographics
NPI:1427185933
Name:HARBOR HEALTHCARE INC
Entity Type:Organization
Organization Name:HARBOR HEALTHCARE INC
Other - Org Name:PARK DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LOFLIN
Authorized Official - Last Name:WERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-866-7054
Mailing Address - Street 1:16917 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5703
Mailing Address - Country:US
Mailing Address - Phone:562-866-7054
Mailing Address - Fax:562-867-8053
Practice Address - Street 1:9266 PARK ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5658
Practice Address - Country:US
Practice Address - Phone:562-866-7054
Practice Address - Fax:562-867-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60263IMedicaid