Healthcare Provider Details

I. General information

NPI: 1558624254
Provider Name (Legal Business Name): WMJR ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10433 W MCNICHOLS RD
DETROIT MI
48221-2355
US

IV. Provider business mailing address

10433 W MCNICHOLS RD
DETROIT MI
48221-2355
US

V. Phone/Fax

Practice location:
  • Phone: 313-736-5041
  • Fax:
Mailing address:
  • Phone: 313-736-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: MR. JOHN ALLEN MCCLENDON JR.
Title or Position: OWNER
Credential:
Phone: 313-671-0389