Healthcare Provider Details

I. General information

NPI: 1104745751
Provider Name (Legal Business Name): HARBOR LIGHT CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 OBERY ST
PLYMOUTH MA
02360-2129
US

IV. Provider business mailing address

19 OBERY ST
PLYMOUTH MA
02360-2129
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-4790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: AARON CHESLEY
Title or Position: MANAGER
Credential:
Phone: 562-682-8864