Healthcare Provider Details

I. General information

NPI: 1861339558
Provider Name (Legal Business Name): MICHAELA JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 W SAMARIA RD
TEMPERANCE MI
48182-2501
US

IV. Provider business mailing address

1460 W SAMARIA RD
TEMPERANCE MI
48182-2501
US

V. Phone/Fax

Practice location:
  • Phone: 734-693-0905
  • Fax:
Mailing address:
  • Phone: 734-693-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: