Provider Demographics
NPI:1750559134
Name:HARBOR VIEW HOUSE
Entity type:Organization
Organization Name:HARBOR VIEW HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILBUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-547-3341
Mailing Address - Street 1:921 S BEACON ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3740
Mailing Address - Country:US
Mailing Address - Phone:310-547-3341
Mailing Address - Fax:
Practice Address - Street 1:921 S BEACON ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3740
Practice Address - Country:US
Practice Address - Phone:310-547-3341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility