Provider Demographics
NPI:1922166123
Name:HARBOR HOUSE INCORPORATED OF FORT SMITH ARKANSAS
Entity Type:Organization
Organization Name:HARBOR HOUSE INCORPORATED OF FORT SMITH ARKANSAS
Other - Org Name:HARBOR HOUSE, INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-785-4083
Mailing Address - Street 1:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72914-4207
Mailing Address - Country:US
Mailing Address - Phone:479-785-4083
Mailing Address - Fax:479-494-7726
Practice Address - Street 1:615 N 19TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3319
Practice Address - Country:US
Practice Address - Phone:479-785-4083
Practice Address - Fax:479-668-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR236252526Medicaid
AR239197526Medicaid