Healthcare Provider Details

I. General information

NPI: 1922166123
Provider Name (Legal Business Name): HARBOR HOUSE INCORPORATED OF FORT SMITH ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N 19TH ST
FORT SMITH AR
72901-3319
US

IV. Provider business mailing address

PO BOX 4207
FORT SMITH AR
72914-4207
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-4083
  • Fax: 479-668-2059
Mailing address:
  • Phone: 479-785-4083
  • Fax: 479-494-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. RANEE LEWIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 479-785-4083