Healthcare Provider Details

I. General information

NPI: 1083637979
Provider Name (Legal Business Name): HARBOR HOUSE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 LAKE DR STE 100 SUITE 100
SINGER ISLAND FL
33404-3846
US

IV. Provider business mailing address

1090 CORAL WAY
SINGER ISLAND FL
33404-2709
US

V. Phone/Fax

Practice location:
  • Phone: 561-863-0522
  • Fax:
Mailing address:
  • Phone: 561-386-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. DARLENE DENISE HUDSON
Title or Position: ADULT FAMILY CARE HOME ADMINISTRATO
Credential: ARNP
Phone: 561-315-3821