Provider Demographics
NPI:1639065402
Name:MY HOUSE YOUR HOME
Entity type:Organization
Organization Name:MY HOUSE YOUR HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LASHIEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON BIRKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-202-0001
Mailing Address - Street 1:41277 W CIELO LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3783
Mailing Address - Country:US
Mailing Address - Phone:480-202-0001
Mailing Address - Fax:
Practice Address - Street 1:41277 W CIELO LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-3783
Practice Address - Country:US
Practice Address - Phone:480-202-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child