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General NPI Number Information
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NPI Number | 1629921283
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Entity Type | Organization
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Legal Business Name | TRIPLE JS EXCELLENT CARE INC
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 18722 WOODSIDE ST
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City | HARPER WOODS
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State | MI
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Zip | 48225-2122
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Country | US
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Telephone | 313-695-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 46828 EMERALD CREEK DR
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-5580
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JEFFERY EDIAGBONYA
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Credential |
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Telephone | 313-695-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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