Provider Demographics
NPI:1659468882
Name:KATIE EDWARDS HOUSE LLC
Entity Type:Organization
Organization Name:KATIE EDWARDS HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:313-341-4323
Mailing Address - Street 1:8635 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2041
Mailing Address - Country:US
Mailing Address - Phone:313-341-4323
Mailing Address - Fax:313-341-4323
Practice Address - Street 1:8635 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2041
Practice Address - Country:US
Practice Address - Phone:313-341-4323
Practice Address - Fax:313-341-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness