CCRC - SOUTH PORT SQUARE, LLC (NPI# 1376957803) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376957803 |
| Entity Type | Organization |
| Organization Name | CCRC - SOUTH PORT SQUARE, LLC |
| Other Organization Name | HARBOUR HEALTH CENTER |
| Practice Address |
23013 Westchester Blvd Port Charlotte FL 33980-8448 |
| Mailing Address |
1920 Main St Ste 1200 Irvine CA 92614-7230 |
| Practice Telephone | 9416251220 |
| Mailing Telephone | 9494070700 |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2020-07-22 |
| Authorized Official Name | JEFFREY MILLER (CEO/PRESIDENT) |
| Authorized Official Telephone | 9494070700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Harbour Health Center | Doing Business As Name - Organization |
| Street Address |
23013 WESTCHESTER BLVD |
| City | PORT CHARLOTTE |
| State | FL |
| Zip Code | 33980-8448 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689656845 | Harbour Health Systems LLC | Home Health | 23013 Westchester Blvd, Port Charlotte, FL 33980-8448 | 2005-11-15 |
| 1124583158 | Jennifer Lynn Azelton | Nurse Practitioner | 23013 Westchester Blvd, Port Charlotte, FL 33980-8448 | 2019-02-04 |
| 1346631132 | Jacelyn Jennings | Occupational Therapist | 23013 Westchester Blvd, Port Charlotte, FL 33980-8448 | 2015-02-15 |
| 1780873638 | Alice G Hamilton | Occupational Therapist | 23013 Westchester Blvd, Port Charlotte, FL 33980-8448 | 2007-10-16 |
| 1841488475 | Jennifer A Cooley | Occupational Therapy Assistant | 23013 Westchester Blvd, Port Charlotte, FL 33980-8448 | 2007-10-09 |
| 1043401714 | Nicky Patel | Physical Therapist | 23013 Westchester Blvd, Port Charlotte, FL 33980-8448 | 2007-08-07 |
| 1912101122 | Harbour Health Systems LLC | Home Health | 23013 Westchester Blvd, Port Charlotte, FL 33980-8448 | 2007-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144699646 | Raymond B Hendricks | Custodial Care Facility | 1306 Annette St, Port Charlotte, FL 33980 | 2015-09-15 |
| 1649616517 | Anne Yvonne Clarke | Nurse's Aide | 3378 Idlewild Street, Port Charlotte, FL 33980 | 2013-05-17 |
| 1427395680 | John F Guarino Md Pa | Surgery | 4245 Kings Hwy, Unit A, Port Charlotte, FL 33980 | 2013-01-08 |
| 1497049027 | Patricia Ann Drow | Occupational Therapist | 24469 Manchester Trail, Port Charlotte, FL 33980 | 2011-05-31 |
| 1811221484 | Amanda K Huffman | Clinical Nurse Specialist | 22655 Bayshore Rd Ste 130, Port Charlotte, FL 33980 | 2009-09-29 |
| 1093967739 | Donna Olson | Nurse Practitioner | 1100 Loveland Boulevard, Port Charlotte, FL 33980 | 2008-10-14 |
| 1821278029 | Paula Marie Allison | Dietitian, Registered | 23422 Burlingame Ave, Port Charlotte, FL 33980 | 2007-11-06 |
| 1689865891 | Keith Anthony Williams | Physical Medicine & Rehabilitation | 4265 Laura Street, Port Charlotte, FL 33980 | 2007-08-05 |
| 1578685491 | Richard Michael Cocchieri | Dentist | Florida Department of Health In Charlotte County, 1100 Loveland Boulevard, Port Charlotte, FL 33980 | 2007-04-03 |
| 1417989328 | John F Guarino | Surgery | 4245 Kings Highway, Unit A, Port Charlotte, FL 33980 | 2006-07-07 |
| Find all providers in zip 33980 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396754230 | Health Center of Port Charlotte Inc | Skilled Nursing Facility | 4000 Kings Hwy, Port Charlotte, FL 33980-8413 | 2006-08-07 |
| 1043233992 | Port Charlotte Facility Operations, LLC | Skilled Nursing Facility | 18480 Cochran Blvd, Port Charlotte, FL 33948-3379 | 2006-07-25 |
| 1396778825 | Hqm of Port Charlotte, LLC | Skilled Nursing Facility | 4033 Beaver Ln, Port Charlotte, FL 33952-9206 | 2006-07-08 |
| 1740220227 | Tandem Health Care of Port Charlotte, Inc. | Skilled Nursing Facility | 18480 Toledo Blade Blvd, Port Charlotte, FL 33948-3379 | 2006-06-07 |
| 1124002647 | Peace River Hma Nursing Center Inc | Skilled Nursing Facility | 2370 Harbor Blvd, Port Charlotte, FL 33952 | 2005-11-30 |
| 1679560262 | Deep Creek Rnc, LLC | Skilled Nursing Facility | 25325 Rampart Blvd, Port Charlotte, FL 33983 | 2005-09-29 |
| 1275904864 | Solaris Healthcare Charlotte Harbor LLC | Skilled Nursing Facility | 4000 Kings Hwy, Port Charlotte, FL 33980-8718 | 2015-10-08 |
| 1033586060 | Mary Samoge-wismer | Skilled Nursing Facility | 18480 Cochran Blvd, Port Charlotte, FL 33948-3379 | 2015-08-25 |
| 1467761783 | Charlotte Harbor Rehab LLC | Skilled Nursing Facility | 4000 Kings Hwy, Port Charlotte, FL 33980-8718 | 2010-10-04 |
| 1801062880 | Village Place Nh LLC | Skilled Nursing Facility | 2370 Harbor Blvd, Port Charlotte, FL 33952-5024 | 2008-04-30 |
| Find all providers in PORT CHARLOTTE | ||||
| City | PORT CHARLOTTE |
| Zip Code | 33980 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.