MEDICARE: HARBOR HOUSE ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	177F00000X	Lodging Provider		FL

General Provider Information

NPI Number	:	1083637979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR HOUSE ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	1090 CORAL WAY
Second Line	:
City	:	SINGER ISLAND
State	:	FL
Zip	:	33404-2709
Country	:	US
Telephone Number	:	561-386-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 LAKE DR STE 100
Second Line	:	SUITE 100
City	:	SINGER ISLAND
State	:	FL
Zip	:	33404-3846
Country	:	US
Telephone Number	:	561-863-0522
Fax Number	:

Authorized Official
Title or Position	:	ADULT FAMILY CARE HOME ADMINISTRATO
Name	:	MS. DARLENE DENISE HUDSON
Credential	:	ARNP
Telephone Number	:	561-315-3821

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/22/2020

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