Provider Demographics
NPI:1376777805
Name:EMMANUEL HOUSE 1&2 INC.
Entity Type:Organization
Organization Name:EMMANUEL HOUSE 1&2 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCHE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-729-4547
Mailing Address - Street 1:18425 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2707
Mailing Address - Country:US
Mailing Address - Phone:313-729-4547
Mailing Address - Fax:313-372-8717
Practice Address - Street 1:18425 HICKORY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2707
Practice Address - Country:US
Practice Address - Phone:313-729-4547
Practice Address - Fax:313-372-8717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMMANUEL HOUSE 1& 2 INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-12
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty