Organization
MICHIGAN MAGICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEVON JOHNSON (MENTAL HEALTH SPECIALIST)
(313) 587-6940
Entity
Organization
Contact information
Practice address
5870 OAKMAN BLVD, DETROIT, MI 48204-3060
(313) 587-6940
Mailing address
PO BOX 7048, DEARBORN, MI 48121-7048
(313) 587-6940
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
01/30/2024
Last updated
01/30/2024
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