Healthcare Provider Details

I. General information

NPI: 1649190679
Provider Name (Legal Business Name): MESIAH GARRISON DCW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 E GEORGE AVE
HAZEL PARK MI
48030
US

IV. Provider business mailing address

20101 W CHICAGO ST APT 102
DETROIT MI
48228-1570
US

V. Phone/Fax

Practice location:
  • Phone: 313-319-2402
  • Fax:
Mailing address:
  • Phone: 313-319-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: