Provider Demographics
NPI:1831711258
Name:HARBOR HEALTH INTEGRATED CARE LLC
Entity type:Organization
Organization Name:HARBOR HEALTH INTEGRATED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNWICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-900-8082
Mailing Address - Street 1:1717 W NORTHERN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5478
Mailing Address - Country:US
Mailing Address - Phone:888-900-8082
Mailing Address - Fax:
Practice Address - Street 1:1717 W NORTHERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5478
Practice Address - Country:US
Practice Address - Phone:888-900-8082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No283Q00000XHospitalsPsychiatric HospitalGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine