Provider Demographics
NPI:1639244734
Name:CLEAN HOUSE, INC.
Entity type:Organization
Organization Name:CLEAN HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOCHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:248-568-4000
Mailing Address - Street 1:24750 SWANSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5320
Mailing Address - Country:US
Mailing Address - Phone:248-357-0600
Mailing Address - Fax:248-357-5008
Practice Address - Street 1:24750 SWANSON RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5320
Practice Address - Country:US
Practice Address - Phone:248-357-0600
Practice Address - Fax:248-357-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI631213251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION78990Medicare ID - Type UnspecifiedFACILITY PROVIDER CODE