=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720126204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAM SENIOR SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2980 DORR RD SUITE 102
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48116-9459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-229-0200
-----------------------------------------------------
Fax | 810-220-7916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2980 DORR RD SUITE 102
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48116-9459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-229-0200
-----------------------------------------------------
Fax | 810-220-7916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MRS. MARYANN MADSEN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 810-229-0200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372500000X
-----------------------------------------------------
Taxonomy Name | Chore Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------