Healthcare Provider Details

I. General information

NPI: 1639654643
Provider Name (Legal Business Name): HARBOR HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BIRCH HILL DR
NASHUA NH
03063-2541
US

IV. Provider business mailing address

77 NORTHEASTERN BLVD
NASHUA NH
03062-3128
US

V. Phone/Fax

Practice location:
  • Phone: 603-821-7788
  • Fax: 603-821-5620
Mailing address:
  • Phone: 603-882-3616
  • Fax: 866-881-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN CANAWAY
Title or Position: CREDENTIALING/CONTRACTING
Credential:
Phone: 603-882-3616