Provider Demographics
NPI:1689656845
Name:HARBOUR HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:HARBOUR HEALTH SYSTEMS LLC
Other - Org Name:HARBOUR HEALTH CENTER, HARBOUR TERRACE, HARBOUR HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:BOWEN
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:941-625-1220
Mailing Address - Street 1:23013 WESTCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8448
Mailing Address - Country:US
Mailing Address - Phone:941-625-1220
Mailing Address - Fax:941-625-5649
Practice Address - Street 1:23013 WESTCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8448
Practice Address - Country:US
Practice Address - Phone:941-625-1220
Practice Address - Fax:941-625-5649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991017251E00000X
FLAL5075310400000X
FLSNF1504096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031933300Medicaid
FLK3COtherBLUECROSS/BLUE SHIELD
FLK3COtherBLUECROSS/BLUE SHIELD