Provider Demographics
NPI:1548892029
Name:HARBOUR HOUSE, INC
Entity type:Organization
Organization Name:HARBOUR HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-893-1080
Mailing Address - Street 1:15 OAK CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7017
Mailing Address - Country:US
Mailing Address - Phone:410-266-3040
Mailing Address - Fax:443-378-3540
Practice Address - Street 1:1521 WIDOWS MITE RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2144
Practice Address - Country:US
Practice Address - Phone:410-255-3539
Practice Address - Fax:443-378-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1518431170Medicaid