NPIMap

Organization Active NPI

Harbortown Treatment Center PLLC

  • Methadone Clinic
  • Benton Harbor, MI
National Provider Identifier
1154414183
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
110093 Issued in MI
Legal business name
HARBORTOWN TREATMENT CENTER PLLC
Practice address
1022 E Main St
Benton Harbor, MI 49022-3036
Phone
(269) 926-0015
Fax
(269) 926-0123
NPI assigned
Oct 2, 2006
Last updated
May 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Darien SmithNPI 1205259074
Title
Program Director
Phone
(269) 926-0015

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X 110093 MI Primary

Addresses

Primary practice location

1022 E Main St
Benton Harbor, MI 49022-3036

Mailing address

1022 E Main St
P.O. Box 929
Benton Harbor, MI 49022-3036
Phone (269) 926-0015

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080509000650 MI Part B Supplier - Clinic/Group Practice 3971682352 Receives reassigned benefits from 4 practitioners
Practice locations: Benton Harbor, MI
O20200116001023 MI Part B Supplier - Opioid Treatment Program (Otp) 3971682352 Practice locations: Benton Harbor, MI

National Provider Directory

National Provider Directory

Locations

1022 E Main St
#929
Benton Harbor, MI 49022
Phone (269) 926-0015

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1154414183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 E MAIN ST",
            "address_2": "P.O. BOX 929",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490223036",
            "telephone_number": "269-926-0015",
            "fax_number": "269-926-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 E MAIN ST",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490223036",
            "telephone_number": "269-926-0015",
            "fax_number": "269-926-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBORTOWN TREATMENT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DARIEN",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "269-926-0015",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MI",
            "license": "110093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton Harbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.