Provider Demographics
NPI:1578702908
Name:FAITH HARBOR
Entity Type:Organization
Organization Name:FAITH HARBOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-366-6843
Mailing Address - Street 1:1043 PEDIGO WAY STE 7
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7197
Mailing Address - Country:US
Mailing Address - Phone:270-366-6843
Mailing Address - Fax:270-842-6213
Practice Address - Street 1:1512 RICHPOND ROCKFIELD RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-7408
Practice Address - Country:US
Practice Address - Phone:270-366-6843
Practice Address - Fax:270-842-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child