Provider Demographics
NPI:1528441425
Name:HAUSE, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:HAUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 S HURON RIVER DR TRLR 9
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9304
Mailing Address - Country:US
Mailing Address - Phone:734-782-2682
Mailing Address - Fax:
Practice Address - Street 1:4624 S HURON RIVER DR TRLR 9
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-9304
Practice Address - Country:US
Practice Address - Phone:734-782-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
1940OtherMICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES