Healthcare Provider Details

I. General information

NPI: 1699777276
Provider Name (Legal Business Name): HARBORS HOME HEALTH & HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 7TH STREET
HOQUIAM WA
98550
US

IV. Provider business mailing address

201 7TH STREET
HOQUIAM WA
98550
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-5454
  • Fax: 360-533-0999
Mailing address:
  • Phone: 360-532-5454
  • Fax: 360-533-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberIS-306
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberIS-306
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIS-306
License Number StateWA

VIII. Authorized Official

Name: MR. TOM MAYR
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 360-532-5454