# LAKE FENTON HAUS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811067465
- **Authorized official:** MRS. KATHLEEN MARIE HUBER EXECUTIVE DIRECTOR (OWNER EXECUTIVE DIRECTOR)
- **Authorized official phone:** (810) 629-7969

## Contact information

- **Practice address:** 12287 MARGARET DR, FENTON, MI 48430
- **Practice address phone:** (810) 629-7969
- **Mailing address:** 12287 MARGARET DR, FENTON, MI 48430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/09/2006
- **Last updated:** 08/22/2020