Healthcare Provider Details

I. General information

NPI: 1861158479
Provider Name (Legal Business Name): MJ SENIOR HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23229 NINE MACK DR
SAINT CLAIR SHORES MI
48080-1969
US

IV. Provider business mailing address

23229 NINE MACK DR
SAINT CLAIR SHORES MI
48080-1969
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-9217
  • Fax: 586-777-5222
Mailing address:
  • Phone: 586-777-9217
  • Fax: 586-777-5222

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANA GRACE AZZOUG
Title or Position: OWNER
Credential:
Phone: 313-450-3601