Healthcare Provider Details

I. General information

NPI: 1538304373
Provider Name (Legal Business Name): HARBOR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 CAROLINA AVE
WASHINGTON NC
27889-3315
US

IV. Provider business mailing address

1724 CAROLINA AVE
WASHINGTON NC
27889-3315
US

V. Phone/Fax

Practice location:
  • Phone: 252-945-3383
  • Fax:
Mailing address:
  • Phone: 252-945-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMHL-007-070
License Number StateNC

VIII. Authorized Official

Name: MR. MATTHEW HARRUP
Title or Position: PRESIDENT
Credential:
Phone: 252-945-3383