Provider Demographics
NPI:1003359936
Name:MY SISTERS HOUSE FOR GIRLS, INC.
Entity Type:Organization
Organization Name:MY SISTERS HOUSE FOR GIRLS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNABBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-322-1587
Mailing Address - Street 1:4540 WOOLCUT LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7667
Mailing Address - Country:US
Mailing Address - Phone:419-322-1587
Mailing Address - Fax:
Practice Address - Street 1:4540 WOOLCUT LN
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7667
Practice Address - Country:US
Practice Address - Phone:419-322-1587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ICONIC ENTERPRISES, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-26
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness