Healthcare Provider Details

I. General information

NPI: 1639590409
Provider Name (Legal Business Name): HARBOR OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2013
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WASHINGTON ST NW
WARREN OH
44483-4735
US

IV. Provider business mailing address

202 WASHINGTON ST NW
WARREN OH
44483-4735
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-8997
  • Fax:
Mailing address:
  • Phone: 330-399-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMUEL SHERMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-621-5400