Provider Demographics
NPI:1336753110
Name:MOMMA'S HOUSE COMMUNITY DEVELOPMENT CENTER, INC.
Entity Type:Organization
Organization Name:MOMMA'S HOUSE COMMUNITY DEVELOPMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:419-307-7973
Mailing Address - Street 1:154 CHESTERFIELD LN APT 8
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3885
Mailing Address - Country:US
Mailing Address - Phone:419-307-7973
Mailing Address - Fax:
Practice Address - Street 1:600 SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4636
Practice Address - Country:US
Practice Address - Phone:419-307-7973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management