Provider Demographics
NPI:1700249869
Name:HARBOR CARE HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:HARBOR CARE HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/CONTRACTING SPECIALIS
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-882-3616
Mailing Address - Street 1:45 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3312
Mailing Address - Country:US
Mailing Address - Phone:603-882-3616
Mailing Address - Fax:
Practice Address - Street 1:45 HIGH ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3312
Practice Address - Country:US
Practice Address - Phone:603-882-3616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBOR HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-05
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHPENDINGMedicaid