Provider Demographics
NPI:1932784485
Name:HARBORAGE CARE MD
Entity Type:Organization
Organization Name:HARBORAGE CARE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-373-7334
Mailing Address - Street 1:19311 BOULDER BAY LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3731
Mailing Address - Country:US
Mailing Address - Phone:832-373-7334
Mailing Address - Fax:
Practice Address - Street 1:19311 BOULDER BAY LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3731
Practice Address - Country:US
Practice Address - Phone:832-373-7334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home