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General NPI Number Information
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NPI Number | 1609954668
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Entity Type | Organization
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Legal Business Name | MJM HEALTH AGENCY, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5517 SOUTH MICHIGAN STREET LOWER LEVEL
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City | CHICAGO
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State | IL
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Zip | 60615
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Country | US
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Telephone | 773-643-0227
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Fax | 773-643-0227
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Provider Business Mailing Address
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Address Line | 12807 FALCON CT
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City | LEMONT
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State | IL
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Zip | 60439-7300
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Country | US
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Telephone | 773-643-0227
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Fax | 773-643-0227
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KEMI ASSISAT ANDU-ALAUSA
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Credential | CPA, MBA
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Telephone | 630-670-6416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1765224
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License Number State | IL
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