Provider Demographics
NPI:1164569802
Name:PDHCRC, INC.
Entity Type:Organization
Organization Name:PDHCRC, INC.
Other - Org Name:POTENTIAL DEVELOPMENT HOMES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:EMILY
Authorized Official - Last Name:FREYSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-784-4426
Mailing Address - Street 1:205 17TH ST
Mailing Address - Street 2:P.O. BOX 1978
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1403
Mailing Address - Country:US
Mailing Address - Phone:517-784-4426
Mailing Address - Fax:
Practice Address - Street 1:205 17TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-1403
Practice Address - Country:US
Practice Address - Phone:517-784-4426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL380007055320600000X, 320900000X
320900000X, 385H00000X
MIAL380007059320900000X
MIDC380253832385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child