Provider Demographics
NPI:1275975179
Name:LITTLE RED HOUSE INC.
Entity Type:Organization
Organization Name:LITTLE RED HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HERRELKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-846-5720
Mailing Address - Street 1:311 E EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2022
Mailing Address - Country:US
Mailing Address - Phone:616-846-5720
Mailing Address - Fax:616-935-0688
Practice Address - Street 1:311 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2022
Practice Address - Country:US
Practice Address - Phone:616-846-5720
Practice Address - Fax:616-935-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
154433127/3YMV1OtherSAM