NPIMap

Organization Active NPI

Harbor Healthcare Inc

Doing business as Clark Division

  • Intellectual Disabilities Intermediate Care Facility
  • Bellflower, CA
National Provider Identifier
1518095819
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
HARBOR HEALTHCARE INC
Doing business as
Clark Division
Practice address
13638 Clark Ave
Bellflower, CA 90706-2203
Phone
(562) 866-7054
Fax
(562) 867-8053
NPI assigned
Mar 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Cheryl Loflin Wertz
Title
Ceo
Phone
(562) 866-7054

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

13638 Clark Ave
Bellflower, CA 90706-2203

Mailing address

16917 Clark Ave
Bellflower, CA 90706-5703
Phone (562) 866-7054

Other identifiers 1

IdentifierTypeStateIssuer
LTC60444IMedicaidCA

Other names 1

  • CLARK DIVISION Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518095819. Details of each certification follow.

  • CCN 05G555 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G555

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CLARK DIVISION
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Feb 8, 1992
Last certification
Jun 4, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
13638 Clark Avenue
Bellflower, CA 90706

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
05D2034255Harbor Health Care Inc, Clark Division13638 S Clark Ave, Bellflower, CA 90706Certificate of waiverDec 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Harbor Healthcare Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1518095819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16917 CLARK AVE",
            "city": "BELLFLOWER",
            "state": "CA",
            "postal_code": "907065703",
            "telephone_number": "562-866-7054",
            "fax_number": "562-867-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13638 CLARK AVE",
            "city": "BELLFLOWER",
            "state": "CA",
            "postal_code": "907062203",
            "telephone_number": "562-866-7054",
            "fax_number": "562-867-8053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WERTZ",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "LOFLIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-866-7054",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60444I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLARK DIVISION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellflower, CA

Sources for this page

Verify at the official NPI Registry.