Healthcare Provider Details

I. General information

NPI: 1851603286
Provider Name (Legal Business Name): MJ GENERAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE STE 230
WASHINGTON DC
20020-7038
US

IV. Provider business mailing address

2041 MARTIN LUTHER KING JR AVE SE STE 230
WASHINGTON DC
20020-7038
US

V. Phone/Fax

Practice location:
  • Phone: 202-563-8690
  • Fax: 202-563-8692
Mailing address:
  • Phone: 202-563-8690
  • Fax: 202-563-8692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNEST M IGWACHO
Title or Position: CEO
Credential:
Phone: 202-563-8690