NPIMap

Organization Active NPI

Harbor Homes, Inc.

  • Federally Qualified Health Center (FQHC)
  • Nashua, NH
National Provider Identifier
1699705079
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
850000244 Issued in NH
Legal business name
HARBOR HOMES, INC.
Practice address
45 High St
Nashua, NH 03060
Phone
(603) 882-3616
Fax
(603) 595-7414
NPI assigned
Jul 3, 2006
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Colleen Canaway
Title
Credentialing Specialist
Phone
(603) 882-3616

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Psychologist 103TC0700X NU
Clinical Social Worker 1041C0700X NU
General Practice Dentistry 1223G0001X NU
Family Medicine Physician 207Q00000X 850000244 NH
Internal Medicine Physician 207R00000X 850000244 NH
Psychiatry Physician 2084P0800X 850000244 NH
General Practice Physician 208D00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X 850000244 NH Primary
Substance Abuse Rehabilitation Facility 324500000X NU
Pharmacy 333600000X 0812 P NH
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Primary Care Nurse Practitioner 363LP2300X 850000244 NH
Women's Health Nurse Practitioner 363LW0102X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

45 High St
Nashua, NH 03060

Mailing address

77 Northeastern Blvd
Nashua, NH 03062-3128
Phone (603) 882-3616

Other practice location 1

10 - 12 Amherst Street
Nashua, NH 03060-0306
Phone (603) 821-7888

Other practice location 2

615 Amherst St
Nashua, NH 03063-1052
Phone (603) 881-4848

Other practice location 3

133 Epping Rd Unit B
Exeter, NH 03833-1547
Phone (603) 881-4848

Other identifiers 4

IdentifierTypeStateIssuer
3124700MedicaidNH
3071189MedicaidNH
3082687MedicaidNH
3108699MedicaidNH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090610000043 NH Part A Provider - Federally Qualified Health Center (FQHC) 4587714779 Practice locations: Nashua, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699705079. Details of each certification follow.

Federally qualified health center certification: CCN 301821

Legal name
HARBOR HOMES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 28, 2009
Last certification
Jul 28, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 14, 1980 in NH
Enrollment address
45 High St
Nashua, NH 30603312

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Harbor Homes Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

615 Amherst St
Ste 1
Nashua, NH 03063
Phone (603) 881-4848

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Joel Jaffe Individual OtherSecretary Feb 1, 2014
Richard Plante Individual OtherVice Chair Feb 1, 2014
Henry Och Individual Corporate OfficerCeo and President Nov 1, 2022
Operational/Managerial ControlCeo and President Acting Coo Nov 1, 2022
Vijay Bhatt Individual OtherBoard Member Jan 1, 2017
Lanna Martin Individual OtherBoard Member Feb 26, 2020
Harbor Homes, Inc. Organization, Nashua, NH Non-profit Other Mar 1, 1983
Rosemarie Dykeman Individual OtherBoard Member Apr 28, 2021
Alison C Madden Individual OtherBoard Member Aug 25, 2021
Sekondi Foster Individual OtherBoard Member Apr 28, 2021
Thomas I Arnold Individual OtherBoard Member Jul 1, 2017
Ana Pancine Individual Corporate OfficerCfo May 5, 2021
Daniel Sallet Individual OtherChair of the Board Jan 1, 2011
Vincent Chamberlain Individual OtherBoard Member Feb 1, 2012
Edward McDonough Individual OtherBoard Member Jun 1, 2016
Laurie Goguen Individual OtherAsst. Secretary Jul 1, 2017
Jared Freilich Individual OtherAsst. Treasure Feb 1, 2017

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1699705079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 NORTHEASTERN BLVD",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030623128",
            "telephone_number": "603-882-3616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 HIGH ST",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "03060",
            "telephone_number": "603-882-3616",
            "fax_number": "603-595-7414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 - 12 Amherst Street",
            "address_purpose": "LOCATION",
            "city": "Nashua",
            "state": "NH",
            "postal_code": "030600306",
            "country_code": "US",
            "telephone_number": "603-821-7888",
            "fax_number": "603-821-5620",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "615 Amherst St",
            "address_purpose": "LOCATION",
            "city": "Nashua",
            "state": "NH",
            "postal_code": "030631052",
            "country_code": "US",
            "telephone_number": "603-881-4848",
            "fax_number": "603-598-3644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "133 Epping Rd Unit B",
            "address_purpose": "LOCATION",
            "city": "Exeter",
            "state": "NH",
            "postal_code": "038331547",
            "country_code": "US",
            "telephone_number": "603-881-4848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HARBOR HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "CANAWAY",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "603-882-3616"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "850000244",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "850000244",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NH",
            "license": "850000244",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NH",
            "license": "850000244",
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NH",
            "license": "0812 P",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NH",
            "license": "850000244",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3124700",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3071189",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3082687",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3108699",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashua, NH

Sources for this page

Verify at the official NPI Registry.