MEDICARE: HARBOR HEALTH 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	291U00000X	Clinical Medical Laboratory
2	324500000X	Substance Abuse Rehabilitation Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D2288044	OTHER	CA	CLIA
2	300722AP	OTHER	CA	DEPARTMENT OF HEALTH CARE SERVICES

General Provider Information

NPI Number	:	1548958598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR HEALTH LLC

Provider Business Mailing Address
First Line	:	34405 VIA GOMEZ
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1318
Country	:	US
Telephone Number	:	949-359-5669
Fax Number	:

Provider Business Practice Location Address
First Line	:	34405 VIA GOMEZ
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1318
Country	:	US
Telephone Number	:	949-359-5669
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MATTHEW LEE
Credential	:
Telephone Number	:	619-987-8078

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	01/13/2025

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Directions to “HARBOR HEALTH LLC ” Practice Location

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