Healthcare Provider Details

I. General information

NPI: 1609223338
Provider Name (Legal Business Name): MG AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24718 TEMPLAR AVE
SOUTHFIELD MI
48075-6937
US

IV. Provider business mailing address

24300 SOUTHFIELD RD STE 212
SOUTHFIELD MI
48075-2859
US

V. Phone/Fax

Practice location:
  • Phone: 248-552-8604
  • Fax: 248-552-9614
Mailing address:
  • Phone: 248-552-8604
  • Fax: 248-552-9614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAS630285907
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAS630285907
License Number StateMI

VIII. Authorized Official

Name: MARY GEE-EVANS
Title or Position: PRESIDENT
Credential: MSW,ACSW
Phone: 248-552-8604