Provider Demographics
NPI:1437778586
Name:HARBOUR HOUSE, INC
Entity Type:Organization
Organization Name:HARBOUR HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:LAWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-573-5763
Mailing Address - Street 1:8354 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1701
Mailing Address - Country:US
Mailing Address - Phone:410-255-3539
Mailing Address - Fax:410-255-8583
Practice Address - Street 1:10 OAK CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7017
Practice Address - Country:US
Practice Address - Phone:410-266-3040
Practice Address - Fax:443-378-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD502406400Medicaid