Provider Demographics
NPI:1467517912
Name:OUR HOUSE RESIDENTIAL CARE, INC
Entity Type:Organization
Organization Name:OUR HOUSE RESIDENTIAL CARE, INC
Other - Org Name:OUR HOUSE - SHANNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LENNEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-674-8670
Mailing Address - Street 1:109 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-3109
Mailing Address - Country:US
Mailing Address - Phone:559-674-8670
Mailing Address - Fax:559-673-4825
Practice Address - Street 1:525 SHANNON AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4213
Practice Address - Country:US
Practice Address - Phone:559-673-1922
Practice Address - Fax:559-673-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities