1922166123 NPI number — HARBOR HOUSE INCORPORATED OF FORT SMITH ARKANSAS

Table of content: (NPI 1922166123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922166123 NPI number — HARBOR HOUSE INCORPORATED OF FORT SMITH ARKANSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARBOR HOUSE INCORPORATED OF FORT SMITH ARKANSAS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARBOR HOUSE, INCORPORATED
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922166123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72914-4207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-785-4083
Provider Business Mailing Address Fax Number:
479-494-7726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 N 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72901-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-785-4083
Provider Business Practice Location Address Fax Number:
479-668-2059
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
RANEE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
479-785-4083

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 236252526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 239197526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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