Provider Demographics
NPI:1255668299
Name:GADSON HOUSE OF LIFE
Entity Type:Organization
Organization Name:GADSON HOUSE OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GADSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-303-0397
Mailing Address - Street 1:21810 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2758
Mailing Address - Country:US
Mailing Address - Phone:248-542-5299
Mailing Address - Fax:
Practice Address - Street 1:21810 KIPLING ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2758
Practice Address - Country:US
Practice Address - Phone:248-542-5299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable