Provider Demographics
NPI:1194803403
Name:INNOVATIVE HOUSING DEVELOPMENT CORP
Entity type:Organization
Organization Name:INNOVATIVE HOUSING DEVELOPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEGAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-385-4463
Mailing Address - Street 1:3051 COMMERCE DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3866
Mailing Address - Country:US
Mailing Address - Phone:810-385-4463
Mailing Address - Fax:810-385-8875
Practice Address - Street 1:3051 COMMERCE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3866
Practice Address - Country:US
Practice Address - Phone:810-385-4463
Practice Address - Fax:810-385-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities