Provider Demographics
NPI:1437321957
Name:FUNCTIONAL HOMES, INC.
Entity Type:Organization
Organization Name:FUNCTIONAL HOMES, INC.
Other - Org Name:BARRIER FREE OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/QUEEN
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:269-615-2559
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-0062
Mailing Address - Country:US
Mailing Address - Phone:269-615-2559
Mailing Address - Fax:
Practice Address - Street 1:3235 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-9117
Practice Address - Country:US
Practice Address - Phone:269-615-2559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003832172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty