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General NPI Number Information
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NPI Number | 1336753110
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Entity Type | Organization
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Legal Business Name | MOMMA'S HOUSE COMMUNITY DEVELOPMENT CENTER, INC.
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 600 SAINT JOSEPH ST
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City | FREMONT
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State | OH
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Zip | 43420-4636
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Country | US
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Telephone | 419-307-7973
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Fax |
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Provider Business Mailing Address
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Address Line | 154 CHESTERFIELD LN APT 8
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City | MAUMEE
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State | OH
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Zip | 43537-3885
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Country | US
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Telephone | 419-307-7973
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Fax |
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Authorized Official
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Title or Position | FOUNDER/BOARD PRESIDENT
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Name | CHARI MULLEN
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Credential | M.B.A.
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Telephone | 419-307-7973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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