Provider Demographics
NPI:1013249564
Name:HEDRICK HOUSE INC.
Entity Type:Organization
Organization Name:HEDRICK HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KOLARICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-795-3334
Mailing Address - Street 1:1632 E HEDRICK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2790
Mailing Address - Country:US
Mailing Address - Phone:520-795-3334
Mailing Address - Fax:520-795-1352
Practice Address - Street 1:1632 E HEDRICK DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2790
Practice Address - Country:US
Practice Address - Phone:520-795-3334
Practice Address - Fax:520-795-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility