Provider Demographics
NPI:1740333236
Name:HOUSE OF PHILADELPHIA, INC.
Entity type:Organization
Organization Name:HOUSE OF PHILADELPHIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:HAYDEN
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-824-4689
Mailing Address - Street 1:8571 THREE MILE RD
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:36544-3301
Mailing Address - Country:US
Mailing Address - Phone:251-824-4689
Mailing Address - Fax:251-824-1675
Practice Address - Street 1:8571 THREE MILE RD
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:AL
Practice Address - Zip Code:36544-3301
Practice Address - Country:US
Practice Address - Phone:251-824-4689
Practice Address - Fax:251-824-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities