Provider Demographics
NPI:1528698321
Name:HARBOR VILLAGE INC.
Entity type:Organization
Organization Name:HARBOR VILLAGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:737-247-1223
Mailing Address - Street 1:1515 NW 167TH ST STE 430
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 STATE MARKET RD
Practice Address - Street 2:
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476-1542
Practice Address - Country:US
Practice Address - Phone:561-876-1498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No283Q00000XHospitalsPsychiatric Hospital
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health