Healthcare Provider Details

I. General information

NPI: 1245138429
Provider Name (Legal Business Name): NORTHEAST HARBOR HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2026
Last Update Date: 10/28/2026
Certification Date: 10/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 PARK ST
DEXTER ME
04930-1470
US

IV. Provider business mailing address

16544 FRANZEN FARM RD
SAN DIEGO CA
92127-2240
US

V. Phone/Fax

Practice location:
  • Phone: 858-798-5700
  • Fax:
Mailing address:
  • Phone: 858-798-5700
  • 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: MR. JEFFREY DANA
Title or Position: CFO
Credential:
Phone: 856-430-3198