Provider Demographics
NPI:1235670696
Name:RANDY'S HOUSE
Entity Type:Organization
Organization Name:RANDY'S HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HELMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-498-4608
Mailing Address - Street 1:203 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-1944
Mailing Address - Country:US
Mailing Address - Phone:616-232-2915
Mailing Address - Fax:616-835-9101
Practice Address - Street 1:203 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1944
Practice Address - Country:US
Practice Address - Phone:616-232-2915
Practice Address - Fax:616-835-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISO410408324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISO410408OtherSUD PREVENTION