=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003707886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J,. MAXWELL L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2025
-----------------------------------------------------
Last Update Date | 07/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 474 E MICHIGAN AVE
-----------------------------------------------------
City | HESPERIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49421-9168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-571-8759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 344
-----------------------------------------------------
City | HESPERIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49421-0344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-571-8759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JEANA MARLENE MAXWELL
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 231-571-8759
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------