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General NPI Number Information
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NPI Number | 1669603593
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Entity Type | Organization
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Legal Business Name | HARBOR HOUSES OF JACKSON, INC.
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 07/27/2009
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Provider Practice Location Address
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Address Line | 5354 I 55 S
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City | JACKSON
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State | MS
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Zip | 39272-9119
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Country | US
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Telephone | 601-714-1640
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Fax | 601-371-3272
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Provider Business Mailing Address
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Address Line | PO BOX 2917
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City | JACKSON
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State | MS
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Zip | 39207-2917
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Country | US
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Telephone | 601-714-1640
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Fax | 601-371-3217
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MILTON TROST FRIEDLER
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Credential | LA CPA
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Telephone | 601-714-1640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | MS
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