Provider Demographics
NPI:1346598893
Name:HARBOR HOUSE INC
Entity type:Organization
Organization Name:HARBOR HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATR COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-743-1836
Mailing Address - Street 1:1979 E ALCY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38114-5902
Mailing Address - Country:US
Mailing Address - Phone:901-743-1836
Mailing Address - Fax:901-745-1180
Practice Address - Street 1:1979 E ALCY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-5902
Practice Address - Country:US
Practice Address - Phone:901-743-1836
Practice Address - Fax:901-745-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000010971324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility