Healthcare Provider Details

I. General information

NPI: 1639799356
Provider Name (Legal Business Name): HARBOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 S 66TH AVE
PHOENIX AZ
85043-1922
US

IV. Provider business mailing address

1717 W NORTHERN AVE STE 200
PHOENIX AZ
85021-5478
US

V. Phone/Fax

Practice location:
  • Phone: 888-900-8082
  • Fax:
Mailing address:
  • Phone: 623-213-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHNWICK NATHAN
Title or Position: PRESIDENT
Credential:
Phone: 623-213-5356