Provider Demographics
NPI:1235646266
Name:D & K HARBICK FIVE LLC
Entity type:Organization
Organization Name:D & K HARBICK FIVE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARBICKQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-822-3603
Mailing Address - Street 1:91804 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97413-9711
Mailing Address - Country:US
Mailing Address - Phone:541-822-3603
Mailing Address - Fax:
Practice Address - Street 1:91804 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:BLUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97413-9711
Practice Address - Country:US
Practice Address - Phone:541-822-3603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging