NPIMap

Organization Active NPI

Harbor House, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Goldsboro, NC
National Provider Identifier
1992979447
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL-096-207 Issued in NC
Legal business name
HARBOR HOUSE, INC
Practice address
203 N Jackson St
Goldsboro, NC 27530-3857
Phone
(919) 734-8310
Fax
(919) 734-8310
NPI assigned
Apr 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

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

Authorized official

Name
Mrs. Glenda Wiggins Johnson
Title
Executive Director
Phone
(919) 736-2802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-096-207 NC Primary

Addresses

Primary practice location

203 N Jackson St
Goldsboro, NC 27530-3857

Mailing address

2822 Cashwell Dr # 178
Goldsboro, NC 27534-4302
Phone (919) 736-2802

Other identifiers 1

IdentifierTypeStateIssuer
8301266MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Harbor House Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

203 N Jackson St
Goldsboro, NC 27530
Phone (919) 734-8310

NPI Registry JSON

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

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1992979447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2822 CASHWELL DR # 178",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275344302",
            "telephone_number": "919-736-2802",
            "fax_number": "919-736-2809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 N JACKSON ST",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275303857",
            "telephone_number": "919-734-8310",
            "fax_number": "919-734-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR HOUSE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_middle_name": "WIGGINS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-736-2802",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-096-207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301266",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.