MEDICARE: HARBOR HOUSE ENTERPRISES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	PENDING	FL

General Provider Information

NPI Number	:	1447432315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR HOUSE ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	1090 CORAL WAY
Second Line	:
City	:	SINGER ISLAND
State	:	FL
Zip	:	33404-2709
Country	:	US
Telephone Number	:	561-842-6360
Fax Number	:

Provider Business Practice Location Address
First Line	:	1090 CORAL WAY
Second Line	:
City	:	SINGER ISLAND
State	:	FL
Zip	:	33404-2709
Country	:	US
Telephone Number	:	561-842-5662
Fax Number	:	561-842-6360

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DARLENE D HUDSON
Credential	:	CRNA
Telephone Number	:	561-842-5662

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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