Provider Demographics
NPI:1285378083
Name:HARBORVIEW TIFTON, LLC
Entity type:Organization
Organization Name:HARBORVIEW TIFTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEIBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-804-1661
Mailing Address - Street 1:1451 NEWTON DR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3752
Mailing Address - Country:US
Mailing Address - Phone:229-382-1665
Mailing Address - Fax:
Practice Address - Street 1:1451 NEWTON DR
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3752
Practice Address - Country:US
Practice Address - Phone:229-382-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility