Basic Information
| Provider Information | |||||||||
| NPI: | 1962551648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR HALL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 704 EMMET ST | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497702910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888805511 | ||||||||
| FaxNumber: | 2313475422 | ||||||||
| Practice Location | |||||||||
| Address1: | 704 EMMET ST | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497702910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888805511 | ||||||||
| FaxNumber: | 2313475422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | NEWTON | ||||||||
| AuthorizedOfficialFirstName: | TERRANCE | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8888805511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CADC | ||||||||
| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
No ID Information.