Provider Demographics
NPI:1306170097
Name:MJA HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:MJA HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AIGBEDION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-682-4450
Mailing Address - Street 1:3129 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7506
Mailing Address - Country:US
Mailing Address - Phone:469-682-4450
Mailing Address - Fax:972-602-1745
Practice Address - Street 1:3129 PINE VALLEY DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7506
Practice Address - Country:US
Practice Address - Phone:469-682-4450
Practice Address - Fax:972-602-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health