Provider Demographics
NPI:1225192495
Name:HARBOR HOUSE, INC
Entity Type:Organization
Organization Name:HARBOR HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:WIGGINS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:919-734-8310
Mailing Address - Street 1:2822 CASHWELL DR
Mailing Address - Street 2:#178
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4302
Mailing Address - Country:US
Mailing Address - Phone:919-736-2802
Mailing Address - Fax:
Practice Address - Street 1:2822 CASHWELL DR
Practice Address - Street 2:#178
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4302
Practice Address - Country:US
Practice Address - Phone:919-736-2802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL096146251B00000X, 320800000X
NCMHL096171320800000X
NCMHL096170320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804952Medicaid
NC7805075Medicaid
NC8301626Medicaid
NC8301266Medicaid
NC8301266BMedicaid
NC8301627Medicaid