# HARBOR HEALTH INTEGRATED CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831711258
- **Authorized official:** MR. JOHNWICK NATHAN (OWNER)
- **Authorized official phone:** (888) 900-8082

## Contact information

- **Practice address:** 1717 W NORTHERN AVE STE 200, PHOENIX, AZ 85021-5478
- **Practice address phone:** (888) 900-8082
- **Mailing address:** 1717 W NORTHERN AVE STE 200, PHOENIX, AZ 85021-5478
- **Mailing address phone:** (888) 900-8082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QC1500X | Community Health Clinic/Center | — | NULL | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | — |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | — |
| 283Q00000X | Psychiatric Hospital | — | NULL | — |

## Other

- **Enumeration date:** 05/07/2020
- **Last updated:** 08/31/2020