1164891651 NPI number — HARMONY HOMECARE LLC

Table of content: (NPI 1164891651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164891651 NPI number — HARMONY HOMECARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARMONY HOMECARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164891651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3696 BROADWAY AVE
Provider Second Line Business Mailing Address:
208
Provider Business Mailing Address City Name:
NORTH BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97459-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-267-3190
Provider Business Mailing Address Fax Number:
541-269-7723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
682 ANDERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOS BAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97420-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-267-3190
Provider Business Practice Location Address Fax Number:
541-269-7723
Provider Enumeration Date:
09/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FORRESTER
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
ALICE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
541-267-3190

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  152130 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 525736 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com