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NPI Code Detail

MEDICARE: HARBOUR HEALTH SYSTEMS LLC

MEDICARE: HARBOUR HEALTH SYSTEMS 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
1251E00000XHome Health Agency299991017FL
2310400000XAssisted Living FacilityAL5075FL
3314000000XSkilled Nursing FacilitySNF1504096FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2K3COTHERFLBLUECROSS/BLUE SHIELD

General Provider Information

NPI Number : 1689656845
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARBOUR HEALTH SYSTEMS LLC
Provider Business Mailing Address
First Line : 23013 WESTCHESTER BLVD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33980-8448
Country : US
Telephone Number : 941-625-1220
Fax Number : 941-625-5649
Provider Business Practice Location Address
First Line : 23013 WESTCHESTER BLVD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33980-8448
Country : US
Telephone Number : 941-625-1220
Fax Number : 941-625-5649
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. HENRY BOWEN GILLESPIE
Credential : NHA
Telephone Number : 941-625-1220
Provider Enumeration Date : 11/15/2005
Last Update Date : 12/23/2008

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Directions to “HARBOUR HEALTH SYSTEMS LLC ” Practice Location

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