Healthcare Provider Details

I. General information

NPI: 1972112563
Provider Name (Legal Business Name): MICHIGAN HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 S HUGHES AVE
FRESNO CA
93706-2321
US

IV. Provider business mailing address

1617 W SHAW AVE STE B
FRESNO CA
93711-3507
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-3454
  • Fax:
Mailing address:
  • Phone: 559-347-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SENA STREETS
Title or Position: PROGRAM MANAGER
Credential:
Phone: 559-347-7627