Provider Demographics
NPI:1427864743
Name:MCCALL, JOTARA DENISE
Entity type:Individual
Prefix:
First Name:JOTARA
Middle Name:DENISE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOTARA
Other - Middle Name:DENISE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:735 RUSTIC DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2132
Mailing Address - Country:US
Mailing Address - Phone:989-906-5161
Mailing Address - Fax:
Practice Address - Street 1:735 RUSTIC DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2132
Practice Address - Country:US
Practice Address - Phone:989-906-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS730418321311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home