Healthcare Provider Details

I. General information

NPI: 1730097833
Provider Name (Legal Business Name): MAGNIFICENT HOME HELP AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25137 JOANNE SMITH DR
WARREN MI
48091-3883
US

IV. Provider business mailing address

25137 JOANNE SMITH DR
WARREN MI
48091-3883
US

V. Phone/Fax

Practice location:
  • Phone: 517-554-7964
  • Fax:
Mailing address:
  • Phone: 517-554-7964
  • 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: NICHOLE CHARISSE MAYBERRY
Title or Position: OWNER
Credential:
Phone: 734-846-9664