Provider Demographics
NPI:1669603593
Name:HARBOR HOUSES OF JACKSON, INC.
Entity type:Organization
Organization Name:HARBOR HOUSES OF JACKSON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:TROST
Authorized Official - Last Name:FRIEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:LA CPA
Authorized Official - Phone:601-714-1640
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39207-2917
Mailing Address - Country:US
Mailing Address - Phone:601-714-1640
Mailing Address - Fax:601-371-3217
Practice Address - Street 1:5354 I 55 S
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39272-9119
Practice Address - Country:US
Practice Address - Phone:601-714-1640
Practice Address - Fax:601-371-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility