Provider Demographics
NPI:1710430111
Name:HOUSE OF MINE
Entity Type:Organization
Organization Name:HOUSE OF MINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION TEACHER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDRINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-202-5812
Mailing Address - Street 1:5704 AVENUE O
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4031
Mailing Address - Country:US
Mailing Address - Phone:917-202-5812
Mailing Address - Fax:
Practice Address - Street 1:5704 AVENUE O
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4031
Practice Address - Country:US
Practice Address - Phone:917-202-5812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency