Provider Demographics
NPI:1699777276
Name:HARBORS HOME HEALTH & HOSPICE
Entity type:Organization
Organization Name:HARBORS HOME HEALTH & HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-532-5454
Mailing Address - Street 1:201 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550
Mailing Address - Country:US
Mailing Address - Phone:360-532-5454
Mailing Address - Fax:360-533-0999
Practice Address - Street 1:201 7TH STREET
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550
Practice Address - Country:US
Practice Address - Phone:360-532-5454
Practice Address - Fax:360-533-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS-306208D00000X, 251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9517Z0ZMedicaid
WA50-1525OtherMCR HOSPICE
WA50-7020Medicare ID - Type UnspecifiedMCR HOME HEALTH