Provider Demographics
NPI:1184931347
Name:HOUSE HEALTHCARE INC.
Entity type:Organization
Organization Name:HOUSE HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:DEREBERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-483-9930
Mailing Address - Street 1:PO BOX 74070
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-0070
Mailing Address - Country:US
Mailing Address - Phone:213-483-9930
Mailing Address - Fax:213-483-0905
Practice Address - Street 1:2100 W 3RD ST
Practice Address - Street 2:SUITE 111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1944
Practice Address - Country:US
Practice Address - Phone:213-483-9930
Practice Address - Fax:213-483-0905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE EAR CLINIC INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty