Provider Demographics
NPI:1528589686
Name:OUR HOUSE RESPITE CARE SERVICES
Entity Type:Organization
Organization Name:OUR HOUSE RESPITE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:NEWMAN
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:662-394-9853
Mailing Address - Street 1:2537 BOBOLINK PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8105
Mailing Address - Country:US
Mailing Address - Phone:662-394-9853
Mailing Address - Fax:662-873-2673
Practice Address - Street 1:149 COURT STREET
Practice Address - Street 2:
Practice Address - City:MAYERSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39113
Practice Address - Country:US
Practice Address - Phone:662-394-9853
Practice Address - Fax:662-873-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS385H00000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care