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General NPI Number Information
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NPI Number | 1689656845
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Entity Type | Organization
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Legal Business Name | HARBOUR HEALTH SYSTEMS LLC
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 23013 WESTCHESTER BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-8448
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Country | US
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Telephone | 941-625-1220
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Fax | 941-625-5649
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Provider Business Mailing Address
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Address Line | 23013 WESTCHESTER BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-8448
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Country | US
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Telephone | 941-625-1220
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Fax | 941-625-5649
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. HENRY BOWEN GILLESPIE
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Credential | NHA
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Telephone | 941-625-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299991017
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL5075
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1504096
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License Number State | FL
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