Provider Demographics
NPI:1194314153
Name:WHITE HOUSE SERVICES
Entity type:Organization
Organization Name:WHITE HOUSE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-682-0773
Mailing Address - Street 1:5466 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2328
Mailing Address - Country:US
Mailing Address - Phone:248-682-0773
Mailing Address - Fax:248-682-0912
Practice Address - Street 1:5466 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2328
Practice Address - Country:US
Practice Address - Phone:248-682-0773
Practice Address - Fax:248-682-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home