Organization
HARBOR HOUSE # V
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLENDA JOHNSON (EXECUTIVE DIRECTOR)
(919) 581-3592
Entity
Organization
Contact information
Practice address
1205 S BEST ST, GOLDSBORO, NC 27530-6703
(919) 581-3592
(919) 734-8310
Mailing address
2822 CASHWELL DR # 178, GOLDSBORO, NC 27534-4302
(919) 581-3592
(919) 734-8310
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805805
—
NC
01
—
MHL096180
MENTAL HEALTH LICENCURE
NC
Enumeration date
12/27/2007
Last updated
12/27/2007
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