Healthcare Provider Details

I. General information

NPI: 1548609654
Provider Name (Legal Business Name): ON MY OWN OF MICHIGAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 09/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 KIRTS BLVD STE. 300
TROY MI
48084-4855
US

IV. Provider business mailing address

1250 KIRTS BLVD STE. 300
TROY MI
48084-4855
US

V. Phone/Fax

Practice location:
  • Phone: 248-649-3739
  • Fax: 248-649-3749
Mailing address:
  • Phone: 248-649-3739
  • Fax: 248-649-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER LYNN ROCCANTI
Title or Position: CEO
Credential:
Phone: 248-649-3739