Provider Demographics
NPI:1285485441
Name:MJ PRIVATE DUTY LLC
Entity type:Organization
Organization Name:MJ PRIVATE DUTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-633-5055
Mailing Address - Street 1:21865 BEDFORD VALLEY DR.
Mailing Address - Street 2:STE B
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044
Mailing Address - Country:US
Mailing Address - Phone:248-780-7072
Mailing Address - Fax:
Practice Address - Street 1:21865 BEDFORD VALLEY DR.
Practice Address - Street 2:STE B
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044
Practice Address - Country:US
Practice Address - Phone:248-780-7072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health