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General NPI Number Information
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NPI Number | 1710691514
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Entity Type | Organization
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Legal Business Name | HARVEST HOUSE TRANSITIONAL RESIDENCE, INC.
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 146 CANDY DR
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City | VALLEJO
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State | CA
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Zip | 94589-1403
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Country | US
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Telephone | 707-888-4058
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9063
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City | VALLEJO
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State | CA
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Zip | 94591-9063
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Country | US
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Telephone | 707-888-4058
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TRENNY MCCOLLUMN
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Credential |
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Telephone | 800-577-7358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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