Provider Demographics
NPI:1831494228
Name:HARMONIC FAMILY, L.L.C.
Entity Type:Organization
Organization Name:HARMONIC FAMILY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:VANGORKOM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LISW
Authorized Official - Phone:319-531-1158
Mailing Address - Street 1:1935 1ST AVE SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5325
Mailing Address - Country:US
Mailing Address - Phone:319-531-1158
Mailing Address - Fax:319-538-0461
Practice Address - Street 1:1935 1ST AVE SE
Practice Address - Street 2:SUITE D
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5325
Practice Address - Country:US
Practice Address - Phone:319-531-1158
Practice Address - Fax:319-538-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA062481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty