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NPI Code Detail

MEDICARE: HARAMBEE HOUSE, INC

MEDICARE: HARAMBEE HOUSE, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment Facility24569373MO

General Provider Information

NPI Number : 1760507172
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARAMBEE HOUSE, INC
Provider Business Mailing Address
First Line : 2013 WILLIAMS ST
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-4771
Country : US
Telephone Number : 573-636-8108
Fax Number : 573-635-9892
Provider Business Practice Location Address
First Line : 703 N 8TH ST
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-4516
Country : US
Telephone Number : 573-443-6972
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CHI L CHEUNG
Credential :
Telephone Number : 573-636-8108
Provider Enumeration Date : 03/21/2007
Last Update Date : 08/22/2020

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