Harbor Health Integrated Care Clinic

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

HARBOR HEALTH INTEGRATED CARE CLINIC

Practice address

4805 W Thomas Rd
Phoenix, AZ 85031-4050

Phone

(602) 825-1659

NPI assigned

Jul 27, 2022

Last updated

Jul 27, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

HEART OF HARBOR INTEGRATED CARE INCAs reported in NPPES

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

Authorized official

Name

Wildine Burgess

Title

Ceo

Phone

(240) 350-2863

Specialties & licenses 8

Addresses

Electronic endpoints 1

Tax ID family

Harbor Health Integrated Care Clinic3 organizations share this tax ID, including this one

Part of

Harbor Health Integrated Care Clinic

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Harbor Health Integrated Care Clinic

  • Adult Mental Health Clinic/Center
  • Phoenix, AZ
  • NPI 1043947948
  NPD tax ID
• Heart of Harbor Integrated Care Inc.

  dba Heart Of Care Integrated Health

  • Adult Mental Health Clinic/Center
  • Phoenix, AZ
  • NPI 1750044988
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Heart of Harbor Integrated Care Inc.

  dba Heart Of Care Integrated Health

  • Adult Mental Health Clinic/Center
  • Phoenix, AZ
  • NPI 1750044988
  NPPES parent name

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

{
    "created_epoch": "1658880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1316673874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4908 W SIESTA WAY",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853394229",
            "telephone_number": "240-350-2863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 W THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850314050",
            "telephone_number": "602-825-1659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR HEALTH INTEGRATED CARE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEART OF HARBOR INTEGRATED CARE INC",
        "enumeration_date": "2022-07-27",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-16",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "WILDINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-350-2863"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Computer",
            "affiliation": "N",
            "endpointDescription": "Computer",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Icanotes",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Computer",
            "address_1": "4805 W Thomas Rd",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850314050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Josephine M Haran, NCSP
• Dana Harb, MD
• Julie Marie Harbo, D.V.M.
• Harbor Health
• Harbor Health Integrated Care Clinic
• Harbor Health Integrated Care LLC
• Jeanette Renee Harbour, RN
• Hard Rock Recovery Center LLC
• Tiffany Etheredge Hardaway, M.D.
• Brandy N Harden, LCSW

• Adult Mental Health Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Adult Mental Health Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.