LYDIAS HOUSE (NPI# 1659990208) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659990208 |
| Entity Type | Organization |
| Organization Name | LYDIAS HOUSE |
| Practice Address |
11667 152nd Ave West Olive MI 49460-9232 |
| Practice Telephone | 6168443059 |
| Mailing Telephone | 6168443059 |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2020-04-14 |
| Authorized Official Name | LYDIA HODGES (OWNER) |
| Authorized Official Telephone | 6168443059 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LYDIAS HOUSE IN SOUTHEAST | 4101 Martin Luther King Jr Ave Sw, Washington, DC 20032-1326 |
| Street Address |
11667 152ND AVE |
| City | WEST OLIVE |
| State | MI |
| Zip Code | 49460-9232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902255714 | Matthew Tornga | Family Medicine | 15151 Stanton St Ste A, West Olive, MI 49460 | 2016-06-13 |
| 1407326648 | Bryan Castillo | Physical Therapist | 14715 Mayberry Dr, Port Sheldon, MI 49460-4946 | 2018-11-30 |
| 1699119412 | Ronald Dean Mulder | Obstetrics & Gynecology | 17236 Sandgate Pl, West Olive, MI 49460-8508 | 2013-04-23 |
| 1184610669 | Jack Richard Roossien Jr. | Family Medicine | 15151 Stanton St, Suite A, West Olive, MI 49460-8543 | 2005-09-21 |
| 1598223612 | Lindsey Ann Roossien | Family Medicine | 15151 Stanton St, West Olive, MI 49460-8543 | 2019-03-07 |
| 1609069244 | Eileen Marie Kishman | Physical Therapist | 15151 Stanton St, Suite B, West Olive, MI 49460-8543 | 2007-08-27 |
| 1497947618 | Physiotherapy Associates Inc | Clinic/Center | 15151 Stanton St, Ste B, West Olive, MI 49460-8543 | 2007-08-11 |
| 1740406982 | Jack R. Roossien Jr., M.d.p.c. | Family Medicine | 15151 Stanton St, Suite A, West Olive, MI 49460-8543 | 2007-04-17 |
| 1427086420 | Wendy L Bradley | Physical Therapist | 15151 Stanton St, Suite B, West Olive, MI 49460-8543 | 2006-06-29 |
| 1609802313 | Stanton Crossings Physical Therapy LLC | Physical Therapist | 15151 Stanton St, Suite B, West Olive, MI 49460-8543 | 2006-06-24 |
| Find all providers in zip 49460 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770199507 | Laura Lisa Gonzalez | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 7134 Blankenship Cir, Davison, MI 48423-2317 | 2020-09-17 |
| 1558984377 | Angel Patient Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12601 E Outer Dr, Detroit, MI 48224-4204 | 2020-05-27 |
| 1124667118 | Alternative Community Living, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2678 S Waverly Hwy, Lansing, MI 48911-6303 | 2019-12-23 |
| 1215579537 | Eden Prairie Residential Care Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 302 Welch Blvd, Flint, MI 48503-1105 | 2019-10-09 |
| 1518428333 | Alternative Adult Residence LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 19163 Woodingham Dr, Detroit, MI 48221-1650 | 2019-03-26 |
| 1245701960 | Teresa Elaine Guzman | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 130 Marvin St, Battle Creek, MI 49017-8040 | 2018-12-06 |
| 1508334764 | Marquette Staffing Agency, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 592 Blemhuber Ave, Marquette, MI 49855-4818 | 2018-11-06 |
| 1912481235 | Adrienne Flowers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 18403 Kentucky St, Detroit, MI 48221-2029 | 2018-09-21 |
| 1417431487 | Helping Hands Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5116 18th Rd, Escanaba, MI 49829-9525 | 2018-09-17 |
| 1114434578 | Tina Marie Gretkierewicz | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1595 Fairholme Rd, Grosse Pointe Woods, MI 48236-2362 | 2018-01-08 |
| Find all providers with the same taxonomy | ||||
| City | WEST OLIVE |
| Zip Code | 49460 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.