Provider Demographics
NPI:1083157689
Name:.MO'S SHOWER EXPRESS
Entity type:Organization
Organization Name:.MO'S SHOWER EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MONQUELIA
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:MCCLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:586-235-7098
Mailing Address - Street 1:4154 KLINK ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141
Mailing Address - Country:US
Mailing Address - Phone:586-235-7098
Mailing Address - Fax:
Practice Address - Street 1:4154 KLINK ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2745
Practice Address - Country:US
Practice Address - Phone:586-235-7098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4809251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health