Provider Demographics
NPI:1689831802
Name:HARROGATE FAMILY & HEALTH CARE, INC.
Entity Type:Organization
Organization Name:HARROGATE FAMILY & HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-869-0004
Mailing Address - Street 1:169 WESTMORELAND ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-8253
Mailing Address - Country:US
Mailing Address - Phone:423-869-0004
Mailing Address - Fax:423-869-5555
Practice Address - Street 1:169 WESTMORELAND ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8253
Practice Address - Country:US
Practice Address - Phone:423-869-0004
Practice Address - Fax:423-869-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3385388Medicaid