Active NPI
Harborside of Ohio Limited Partnership
- Skilled Nursing Facility
- Defiance, OH
National Provider Identifier
1972619799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 5129
- Legal business name
- HARBORSIDE OF OHIO LIMITED PARTNERSHIP
- Practice address
- 395 Harding St
Defiance, OH 43512-1315 - Phone
- (419) 784-1450
- Fax
- (419) 784-9190
- NPI assigned
- Aug 22, 2006
- Organization subpart
- Yes
- Parent organization
- SUNBRIDGE HEALTHCARE CORPORATION
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 5129 | OH | Primary |
Addresses
Primary practice location
395 Harding St
Defiance, OH 43512-1315
Mailing address
101 Sun Ave NE
Compliance Department
Albuquerque, NM 87109-4373
Phone (505) 468-5604
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2411885 | Medicaid | OH |
Other names 1
- Twin Rivers Care and Rehabilitation
National Provider Directory
National Provider Directory- Part of
- Terrace Hghts Nursing H
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1262044800000",
"number": "1972619799",
"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": "395 HARDING ST",
"city": "DEFIANCE",
"state": "OH",
"postal_code": "435121315",
"telephone_number": "419-784-1450",
"fax_number": "419-784-9190"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HARBORSIDE OF OHIO LIMITED PARTNERSHIP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE CORPORATION",
"enumeration_date": "2006-08-22",
"last_updated": "2009-12-29",
"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": "5129",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2411885",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Twin Rivers Care and Rehabilitation",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Defiance, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.