1659330496 NPI number — HARBOR HEALTH SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659330496 NPI number — HARBOR HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARBOR HEALTH SERVICES INC
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:
GEIGER GIBSON COMMUNITY HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1659330496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1135 MORTON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTAPAN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02126-2834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-533-2300
Provider Business Mailing Address Fax Number:
617-533-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 MOUNT VERNON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-288-1140
Provider Business Practice Location Address Fax Number:
617-288-3910
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
617-533-2350

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110027821D , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1305395 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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