Provider Demographics
NPI:1083152854
Name:HUBBARD HOUSE INC
Entity Type:Organization
Organization Name:HUBBARD HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-408-6417
Mailing Address - Street 1:7901 HENRY AVE APT F105
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3054
Mailing Address - Country:US
Mailing Address - Phone:267-408-6417
Mailing Address - Fax:267-766-5965
Practice Address - Street 1:7901 HENRY AVE APT F105
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3054
Practice Address - Country:US
Practice Address - Phone:267-408-6417
Practice Address - Fax:267-766-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN084112L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032296880001Medicaid