Provider Demographics
NPI:1477674984
Name:INDEPENDENCE HOUSE, LLC
Entity Type:Organization
Organization Name:INDEPENDENCE HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:ROMANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-350-8070
Mailing Address - Street 1:26900 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5312
Mailing Address - Country:US
Mailing Address - Phone:248-350-8070
Mailing Address - Fax:
Practice Address - Street 1:5561 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1158
Practice Address - Country:US
Practice Address - Phone:248-538-9578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home