Provider Demographics
NPI:1912101122
Name:HARBOUR HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:HARBOUR HEALTH SYSTEMS LLC
Other - Org Name:HARBOUR HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MAXFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:941-235-4520
Mailing Address - Street 1:23013 WESTCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8448
Mailing Address - Country:US
Mailing Address - Phone:941-235-4520
Mailing Address - Fax:941-624-2398
Practice Address - Street 1:23013 WESTCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8448
Practice Address - Country:US
Practice Address - Phone:941-235-4520
Practice Address - Fax:941-624-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991017251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107563Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER NUM.