Provider Demographics
NPI:1578823175
Name:BERTRAM HAUS
Entity Type:Organization
Organization Name:BERTRAM HAUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-743-4020
Mailing Address - Street 1:1330 KENNETH STREET
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2201
Mailing Address - Country:US
Mailing Address - Phone:810-743-4020
Mailing Address - Fax:810-743-7370
Practice Address - Street 1:1330 KENNETH ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-2206
Practice Address - Country:US
Practice Address - Phone:810-743-4020
Practice Address - Fax:810-743-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM250237981261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities