Provider Demographics
NPI:1790039519
Name:HARBOR HOPE INC.
Entity Type:Organization
Organization Name:HARBOR HOPE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-225-9045
Mailing Address - Street 1:1626 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-5025
Mailing Address - Country:US
Mailing Address - Phone:920-225-9045
Mailing Address - Fax:
Practice Address - Street 1:1626 S PARK AVE
Practice Address - Street 2:908 BALDWIN ST
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-5025
Practice Address - Country:US
Practice Address - Phone:920-225-9045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0013938320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities