Provider Demographics
NPI:1720439292
Name:HARBORVIEW JESUP, LLC
Entity Type:Organization
Organization Name:HARBORVIEW JESUP, LLC
Other - Org Name:HARBORVIEW HEALTH SYSTEMS JESUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-427-6858
Mailing Address - Street 1:1090 W ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0508
Mailing Address - Country:US
Mailing Address - Phone:912-427-6858
Mailing Address - Fax:
Practice Address - Street 1:1090 W ORANGE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0508
Practice Address - Country:US
Practice Address - Phone:912-427-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-151-2084314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115414Medicare Oscar/Certification