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General NPI Number Information
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NPI Number | 1720144744
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Entity Type | Organization
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Legal Business Name | OUR HOUSE RESIDENTIAL CARE, INC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 2816 WESTGATE DR
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City | MADERA
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State | CA
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Zip | 93637-4159
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Country | US
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Telephone | 559-661-8961
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Fax | 559-673-4825
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Provider Business Mailing Address
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Address Line | 109 E CENTRAL AVE
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City | MADERA
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State | CA
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Zip | 93638-3109
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Country | US
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Telephone | 559-674-8670
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Fax | 559-673-4825
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | DANA DAWN LENNEMANN
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Credential |
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Telephone | 559-674-8670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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