Provider Demographics
NPI:1114331642
Name:HARBOR HOUSE OF LOUISVILLE
Entity Type:Organization
Organization Name:HARBOR HOUSE OF LOUISVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-719-0072
Mailing Address - Street 1:2231 LOWER HUNTERS TRCE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1358
Mailing Address - Country:US
Mailing Address - Phone:502-719-0072
Mailing Address - Fax:502-719-0078
Practice Address - Street 1:2231 LOWER HUNTERS TRCE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1358
Practice Address - Country:US
Practice Address - Phone:502-719-0072
Practice Address - Fax:502-719-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY058MBB343900000X
KY059MBB343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000225Medicaid