Healthcare Provider Details

I. General information

NPI: 1992812929
Provider Name (Legal Business Name): HARBORLIGHTS NURSING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E 7TH ST
SOUTH BOSTON MA
02127-4346
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 617-268-8968
  • Fax: 617-268-4616
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MARILYN A. WEAVER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7563