Healthcare Provider Details

I. General information

NPI: 1093356610
Provider Name (Legal Business Name): THE HOUSE OF EMMANUEL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 E CARPENTER RD
FLINT MI
48505-2156
US

IV. Provider business mailing address

670 E CARPENTER RD
FLINT MI
48505-2156
US

V. Phone/Fax

Practice location:
  • Phone: 419-944-8845
  • Fax:
Mailing address:
  • Phone: 419-944-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MARCUS GOODWIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 419-944-8845