Provider Demographics
NPI:1275243834
Name:HARRELL HOUSE INCORPORATED
Entity Type:Organization
Organization Name:HARRELL HOUSE INCORPORATED
Other - Org Name:ST. PHILIP BAPTIST CHURCH 'HARRELL HOUSE'
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ISIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:214-578-0221
Mailing Address - Street 1:412 E. ASH STREET
Mailing Address - Street 2:412 E. ASH STREET
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-6474
Mailing Address - Country:US
Mailing Address - Phone:214-578-0221
Mailing Address - Fax:
Practice Address - Street 1:412 E. ASH STREET
Practice Address - Street 2:412 E. ASH STREET
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-6474
Practice Address - Country:US
Practice Address - Phone:214-578-0221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty