PDHCRC, INC.


Address: 205 17th St, Jackson, MI 49203-1403
Phone: 5177844426

PDHCRC, INC. (NPI# 1164569802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1164569802
Entity Type Organization
Organization Name PDHCRC, INC.
Other Organization Name POTENTIAL DEVELOPMENT HOMES, INC.
Practice Address 205 17th St
Jackson
MI 49203-1403
Mailing Address 205 17th St
P.o. Box 1978
Jackson
MI 49203-1403
Practice Telephone 5177844426
Mailing Telephone 5177844426
Enumeration Date 2007-01-31
Last Update Date 2011-06-15
Authorized Official Name MRS. BARBARA EMILY FREYSINGER (EXECUTIVE DIRECTOR)
Authorized Official Telephone 5177844426
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities AL380007055 MI Residential Treatment Facilities
N 320900000X Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities AL380007055 MI Residential Treatment Facilities
N 320900000X Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities AL380007059 MI Residential Treatment Facilities
N 385H00000X Respite Care Respite Care Facility
N 385HR2060X Respite Care
Specialization: Respite Care, Mental Retardation and/or Developmental Disabilities, Child
DC380253832 MI Respite Care Facility
N 385HR2065X Respite Care
Specialization: Respite Care, Physical Disabilities, Child
DC38025383 MI Respite Care Facility
Y 320900000X Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities Residential Treatment Facilities

Other Provider/Organization Names

Other Name Type Code
Potential Development Homes, Inc. Doing Business As Name - Organization

Office Location

Street Address 205 17TH ST
City JACKSON
State MI
Zip Code 49203-1403

Providers in the same location

NPI Name Taxonomy Address Enumeration
1710251566 Cynthia Prough Massage Therapist 205 17th St, Jackson, MI 49203-1403 2012-02-25

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1760900120 Cynthia A Rider Dmd Pllc Oral & Maxillofacial Surgery 2545 Spring Arbor Road, Suite 202, Jackson, MI 49203 2017-09-06
1407224280 Lucinda Gail Taggart Licensed Practical Nurse 1515 Greenwood Ave., Jackson, MI 49203 2015-09-10
1134514045 Christopher Dauterman Registered Nurse 1320 East Mcdevitt, Jackson, MI 49203 2015-03-30
1710386826 Steven Andrew Edwards Social Worker 505 Hickory Court, #2d, Jackson, MI 49203 2014-08-14
1861800666 Michigan Continuum Care Pllc Internal Medicine 1310 Greenwood Ave., Jackson, MI 49203 2014-07-25
1497014831 Barbara Cliffe-miller Physical Therapist 3510 Page Ave, Jackson, MI 49203 2012-05-04
1871822718 Sharon Ann Arendsen Respite Care 4043 Clarkway Rd, Jackson, MI 49203 2009-12-23
1669700456 Teresa Lynn Cox Technician, Other 3884 Franklin Rd., Jackson, MI 49203 2009-12-07
1942537097 Stacy Marie Chinevere I Counselor 326 Johnson St, Jackson, MI 49203 2009-11-11
1366672370 Sarah Elizabeth Hazlett Counselor 1522joy Avenue, Jackson, MI 49203 2009-07-24
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Taxonomy Information

Taxonomy Code 320900000X
Grouping Residential Treatment Facilities
Classification Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
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1871088922 Tate Enterprises, LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 1105 Laura Ave, Jackson, MS 39209-7008 2018-06-29
1609375781 Advancing Opportunities, Inc. Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 976 W Veterans Hwy, Jackson, NJ 08527-3337 2018-02-05
1841670775 The Open Door of Nj Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 319 Sapphire Dr, Jackson, NJ 08527-1364 2015-06-05
1699155887 Developmental Disabilities Association of Nj Inc. Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 609 Henry St, Jackson, NJ 08527-4650 2015-06-03
1982084075 National Mentor Healthcare, LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 880 Wright Debow Rd, Jackson, NJ 08527-5428 2015-06-03
1760861389 The Arc Ocean County Chapter, Inc. Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 76 Buckingham Dr, Jackson, NJ 08527-2640 2015-05-28
1588074116 Morning Star Behavioral Associates LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 219 Quail Crk, Jackson, MO 63755-3810 2014-05-05
1174868707 Household of Faith Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 341 Old Griffin Rd, Jackson, GA 30233-4952 2012-12-07
1053682724 Center for Family Life Extension, Inc. Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 1160 Mclean St, Jackson, MS 39209-7251 2012-01-26
Find all providers in JACKSON

Competitor

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City JACKSON
Zip Code 49203

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Dataset Information

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.

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