Provider Demographics
NPI:1184896904
Name:HARVEST STARTS AT HOME, CDC, INC.
Entity type:Organization
Organization Name:HARVEST STARTS AT HOME, CDC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, HARVEST STARTS AT HOME
Authorized Official - Prefix:DR
Authorized Official - First Name:W.
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:219-938-9400
Mailing Address - Street 1:PO BOX 64835
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46401-0835
Mailing Address - Country:US
Mailing Address - Phone:219-938-9400
Mailing Address - Fax:
Practice Address - Street 1:4700 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2737
Practice Address - Country:US
Practice Address - Phone:219-938-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center