Provider Demographics
NPI:1760651657
Name:HOUSE HOUSE REHABILITATION SERVICES
Entity Type:Organization
Organization Name:HOUSE HOUSE REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WJ
Authorized Official - Last Name:WILUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-386-3838
Mailing Address - Street 1:120 S 30TH ST
Mailing Address - Street 2:IST DIVISION
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3403
Mailing Address - Country:US
Mailing Address - Phone:215-386-3838
Mailing Address - Fax:215-438-4872
Practice Address - Street 1:120 S 30TH ST
Practice Address - Street 2:IST DIVISION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3403
Practice Address - Country:US
Practice Address - Phone:215-386-3838
Practice Address - Fax:215-438-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA807207251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA052071-P5KMedicare PIN