Harbor House Incorporated of Fort Smith Arkansas
Organization Active NPI Substance Abuse Rehabilitation Facility · Fort Smith, AR
NPI 1922166123 · NPPES record last updated Sep 27, 2023
Key facts
- NPI
- 1922166123
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- HARBOR HOUSE INCORPORATED OF FORT SMITH ARKANSAS
- Practice address
- 615 N 19TH St
Fort Smith, AR 72901-3319 - Phone
- (479) 785-4083
- Fax
- (479) 668-2059
- NPI assigned
- Dec 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Ranee Lewis
- Title
- Office Manager
- Phone
- (479) 785-4083
Practitioners 39
-
David R Harris, LPC
-
Peggy Sue Ratliff, LPC
-
Maria Tereza Silva, LAC
-
Jason Waller, LPC
-
Treva Ross Sanders, LPC
-
Angela Campagna, LCSW
-
James Harris, LPC
-
Mandy Tigert, LPC
-
Paul Castillo, LPC
-
Karen S Infield, LPC
-
Dorothy Ranee Lewis, CIT
-
Tyler Limore, CIT, RDS
-
Aimee Anderson, QBHP
-
Sara Benton, CIT
-
Memory Boucher, MS, BA, ADC
-
Brandi Bowling, QBHP
-
Stacey Cooper, QBHP
-
Lou Ann Dunn, BS, MS, PRS, BS
-
Ashley Ellen Green, APRN-CNP, PMHNP-BC
-
Sarah Herron, QBHP
-
Don Hollings, ADC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2019190 | Harbor House, Inc | Certificate of waiver | Jan 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150116001073 | AR | Part B Supplier - Clinic/Group Practice | 9032433222 |
Receives reassigned benefits from 13 practitioners Practice locations: Fayetteville, AR; Russellville, AR; Rogers, AR; Hot Springs, AR; Fort Smith, AR; Conway, AR |
National Provider Directory
Locations
1055 Sunflower Dr
Conway, AR 72034
Phone (501) 431-0075
130 N College Ave
Fayetteville, AR 72701
Phone (479) 263-5680
620 S 21st St
Fort Smith, AR 72901
Phone (479) 395-1599
19 N 5th St
Fort Smith, AR 72901
Phone (877) 602-2847
615 W Grand Ave
Ste A
Hot Springs, AR 71901
Phone (501) 625-2383
511 Union St
Ste 230
Jonesboro, AR 72401
Phone (870) 316-6202
2001 Pershing Cir
North Little Rock, AR 72114
220 W Commercial St
Ste B
Ozark, AR 72949
Phone (479) 214-0050
1200 W Walnut St
Ste 2A
Rogers, AR 72756
Phone (479) 263-5680
702 E 4th St
Russellville, AR 72801
Phone (479) 518-6028
604 Walnut St
Texarkana, AR 71854
Phone (870) 331-0732
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | |||
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
615 N 19TH St
Fort Smith, AR 72901-3319
Mailing address
PO Box 4207
Fort Smith, AR 72914-4207
Phone (479) 785-4083
Other practice location 1
812 Mountain Pine Rd
Hot Springs, AR 71913-9158
Phone (479) 785-4083
Other practice location 2
130 N College Ave
Fayetteville, AR 72701-5311
Phone (479) 263-5680
Other practice location 3
615 N 19th St
Fort Smith, AR 72901-3319
Phone (479) 785-4083 ext. 11
Other practice location 4
605 Alma Blvd.
van buren, AR 72956
Phone (479) 353-2808
Other practice location 5
228 W Tyler Ave
West Memphis, AR 72301-4089
Phone (870) 635-0369
Other practice location 6
604 Walnut St
Texarkana, AR 71854-5220
Phone (870) 331-0732
Other practice location 7
1200 W Walnut St Ste 2A
Rogers, AR 72756-3521
Phone (479) 263-5680
Other practice location 8
220 W Commercial St Ste B
Ozark, AR 72949-3216
Phone (479) 214-0050
Other practice location 9
2001 Pershing Cir
North Little Rock, AR 72114-1841
Phone (479) 785-4083
Other practice location 10
302 E Roosevelt Rd
Little Rock, AR 72206-2304
Phone (479) 785-4083
Other practice location 11
3700 W 65th St
Little Rock, AR 72209-8552
Phone (479) 785-4083
Other practice location 12
511 Union St Ste 230
Jonesboro, AR 72401-2863
Phone (870) 316-6202
Other practice location 13
615 W Grand Ave Ste A
Hot Springs, AR 71901-3927
Phone (501) 625-2383
Other practice location 14
702 E 4th St
Russellville, AR 72801-5225
Phone (479) 518-6028
Other practice location 15
3900 Armour Ave
Fort Smith, AR 72904-4317
Phone (479) 785-4083
Other practice location 16
3811 Rogers Ave
Fort Smith, AR 72903-3045
Phone (479) 785-4083
Other practice location 17
1055 Sunflower Dr
Conway, AR 72034-3685
Phone (479) 785-4083
Other practice location 18
900 Quail Run Dr
Mulberry, AR 72947-8534
Phone (479) 785-4083
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 236252526 | Medicaid | AR | |
| 239197526 | Medicaid | AR |
Other names
- Harbor House, Incorporated
Other providers in Fort Smith, AR
- Krista Hannaman
- Olivia Hanson
- Mohab Haraka
- Stuart Dean Haraway
- Kerri Harber
- Star Harbottle
- Allison Hardin
- Jessica Hare
- Devi Hari
- Adrianne Harless
All providers in Fort Smith, AR · Substance Abuse Rehabilitation Facility in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.