Harborside Troy, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5089 Issued in OH

Legal business name

HARBORSIDE TROY, LLC

Practice address

512 Crescent Dr
Troy, OH 45373-2718

Phone

(937) 335-7161

Fax

(937) 335-0686

NPI assigned

Aug 24, 2006

Organization subpart

Yes

Parent organization

SUNBRIDGE HEALTHCARE CORPORATIONAs reported in NPPES

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

Authorized official

Name

William A Mathies

Title

President Director

Phone

(505) 821-3355

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Troy Care and Rehabilitation Center Doing business as

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

CLIA laboratory certificates

Part of

Terrace Hghts Nursing H

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1487761565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 CRESCENT DR",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453732718",
            "telephone_number": "937-335-7161",
            "fax_number": "937-335-0686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBORSIDE TROY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE CORPORATION",
        "enumeration_date": "2006-08-24",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "MATHIES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT DIRECTOR",
        "authorized_official_telephone_number": "505-821-3355"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "5089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2533691",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Troy Care and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allyson K Halderman, DO
• Mary Jo Hale, LPN
• Nancy Louise Hall, NP
• Yusef A Hammuda, PA
• Michael Eugene Harbaugh, PCC
• Delaney Grace Hardert, DPT
• Bryan Frederick Harju, D.M.D.
• Martha Harris-Luken, MS LSW CCDC111
• Phillip A. K. Hash, D.O., PH.D.
• Blake Hatfield, DO

• Skilled Nursing Facility in Troy, OH
• Providers in Troy, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.