NPIMap

Organization Active NPI

Harborview Tifton, LLC

Doing business as Harborview Tifton

  • Skilled Nursing Facility
  • Tifton, GA
National Provider Identifier
1285378083
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HARBORVIEW TIFTON, LLC
Doing business as
Harborview Tifton
Practice address
1451 Newton Dr
Tifton, GA 31794-3752
Phone
(229) 382-1665
NPI assigned
Apr 27, 2022
Last updated
Apr 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chaim S Leibowitz
Title
Executive Vice President
Phone
(917) 804-1661

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1451 Newton Dr
Tifton, GA 31794-3752

Mailing address

1451 Newton Dr
Tifton, GA 31794-3752
Phone (229) 382-1665

Other names 1

  • Harborview Tifton Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220610002389 GA Part A Provider - Skilled Nursing Facility 4082092507 Practice locations: Tifton, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285378083. Details of each certification follow.

Skilled nursing facility certification: CCN 115412

Legal name
HARBORVIEW TIFTON, LLC
Doing business as
HARBORVIEW TIFTON
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1989
Last certification
Apr 2, 2024
Beds
100
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Harborview Health Systems
Organization structure
LLCProprietary
Incorporated
Dec 30, 2021 in DE
Enrollment address
1451 Newton Dr
Tifton, GA 31794-3752
Nursing home name
HARBORVIEW TIFTON
Affiliated entity
HARBORVIEW HEALTH SYSTEMS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Harborview TiftonCCN 115412 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10082.9 residents per day on average
Chain
Harborview Health Systems22 facilities in the chain
Penalties (3 years)
3Fines totaling $22,032

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2130981Harborview Tifton1451 Newton Drive, Tifton, GA 31794Certificate of waiverMay 21, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David Englander Individual Corporate OfficerChief Executive Officer Apr 1, 2022
Mary Faulk Individual W-2 Managing EmployeeFacility Administrator Apr 1, 2022
CL 2022 Irrv TR Organization, Cedarhurst, NY 5% Or Greater Indirect Ownership Interest Apr 1, 2022 50%
De 2021 Irrv TR Organization, Lawrence, NY 5% Or Greater Indirect Ownership Interest Apr 1, 2022 50%
Chaim Sholom Leibowitz Individual Corporate OfficerExecutive Vice President Apr 1, 2022
Ga NC 14, LLC Organization, Cedarhurst, NY LLC 5% Or Greater Direct Ownership Interest Apr 1, 2022 100%

Facilities with the same owner 17

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 17

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1285378083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 NEWTON DR",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943752",
            "telephone_number": "229-382-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 NEWTON DR",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943752",
            "telephone_number": "229-382-1665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBORVIEW TIFTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "LEIBOWITZ",
        "authorized_official_first_name": "CHAIM",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "917-804-1661"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harborview Tifton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.