Provider Demographics
NPI:1184260317
Name:CHT HARBORCHASE TRS TENANT CORP.
Entity type:Organization
Organization Name:CHT HARBORCHASE TRS TENANT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO FOR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-492-5002
Mailing Address - Street 1:958 20TH PL FL 2
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6420
Mailing Address - Country:US
Mailing Address - Phone:772-492-5002
Mailing Address - Fax:772-492-5005
Practice Address - Street 1:13517 NE 86TH DR
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8912
Practice Address - Country:US
Practice Address - Phone:352-350-5310
Practice Address - Fax:352-775-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility