Provider Demographics
NPI:1740469022
Name:HARBOR HOUSE, INC
Entity type:Organization
Organization Name:HARBOR HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:WIGGINS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:919-252-1868
Mailing Address - Street 1:203 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3857
Mailing Address - Country:US
Mailing Address - Phone:919-581-3592
Mailing Address - Fax:919-734-8310
Practice Address - Street 1:2822 CASHWELL DR # 178
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4302
Practice Address - Country:US
Practice Address - Phone:919-581-3592
Practice Address - Fax:919-734-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804952Medicaid
NC7805075Medicaid
NC8301266BMedicaid
NC8301626Medicaid
NC8301627BMedicaid
NC8301627Medicaid
NC8301266Medicaid