Healthcare Provider Details

I. General information

NPI: 1629921283
Provider Name (Legal Business Name): TRIPLE JS EXCELLENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18722 WOODSIDE ST
HARPER WOODS MI
48225-2122
US

IV. Provider business mailing address

46828 EMERALD CREEK DR
SHELBY TOWNSHIP MI
48315-5580
US

V. Phone/Fax

Practice location:
  • Phone: 313-695-4311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY EDIAGBONYA
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 313-695-4311