Provider Demographics
NPI:1841469608
Name:HARBOR HOUSE COLLABORATIVE
Entity type:Organization
Organization Name:HARBOR HOUSE COLLABORATIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-473-5557
Mailing Address - Street 1:1710 E. PIKES PEAK AVENUE,
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5745
Mailing Address - Country:US
Mailing Address - Phone:719-473-5557
Mailing Address - Fax:719-473-6442
Practice Address - Street 1:1710 E. PIKES PEAK AVENUE,
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5745
Practice Address - Country:US
Practice Address - Phone:719-473-5557
Practice Address - Fax:719-473-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1614-01251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14675773Medicaid
CO1614-01OtherALCOHOL AND DRUG ABUSE DI