Provider Demographics
NPI:1467060053
Name:MICHIGAN HOUSE INC.
Entity Type:Organization
Organization Name:MICHIGAN HOUSE INC.
Other - Org Name:MICHIGAN HOUSE 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:SENA
Authorized Official - Middle Name:
Authorized Official - Last Name:STREETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-347-7627
Mailing Address - Street 1:2014 TULARE ST STE 414
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2015
Mailing Address - Country:US
Mailing Address - Phone:559-347-7627
Mailing Address - Fax:
Practice Address - Street 1:1224 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-5731
Practice Address - Country:US
Practice Address - Phone:559-227-3454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness