Provider Demographics
NPI:1801224704
Name:HARBOR HEALTH SERVICES
Entity Type:Organization
Organization Name:HARBOR HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:IRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-533-2336
Mailing Address - Street 1:1135 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 ELM AVE
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5547
Practice Address - Country:US
Practice Address - Phone:508-778-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL12095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty