Provider Demographics
NPI:1962760967
Name:IN HOUSE HOSPITALITY
Entity type:Organization
Organization Name:IN HOUSE HOSPITALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TREVA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-465-0304
Mailing Address - Street 1:15481 MANOR ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1670
Mailing Address - Country:US
Mailing Address - Phone:313-465-0304
Mailing Address - Fax:
Practice Address - Street 1:15481 MANOR ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1670
Practice Address - Country:US
Practice Address - Phone:313-465-0304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based