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General NPI Number Information
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NPI Number | 1730545146
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Entity Type | Organization
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Legal Business Name | WILLIS HOUSE INCORPORATED
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 82 FRANKLIN BLVD
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City | PONTIAC
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State | MI
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Zip | 48341-1703
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Country | US
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Telephone | 248-320-6569
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Fax | 866-232-1309
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Provider Business Mailing Address
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Address Line | 82 FRANKLIN BLVD
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City | PONTIAC
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State | MI
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Zip | 48341-1703
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Country | US
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Telephone | 248-320-6569
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Fax | 866-232-1309
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ANGELA D BARGE
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Credential | M.B.A
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Telephone | 248-320-6569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | AS630275064
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License Number State | MI
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