Healthcare Provider Details

I. General information

NPI: 1427282136
Provider Name (Legal Business Name): JCB ADULT DAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21500 GREENFIELD RD SUITE 201
OAK PARK MI
48237-3009
US

IV. Provider business mailing address

21500 GREENFIELD RD SUITE 201
OAK PARK MI
48237-3009
US

V. Phone/Fax

Practice location:
  • Phone: 248-556-5819
  • Fax: 248-522-2344
Mailing address:
  • Phone: 248-556-5819
  • Fax: 248-522-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATHERESA JAMES
Title or Position: PRESIDENT
Credential:
Phone: 313-399-1407