Provider Demographics
NPI:1013274844
Name:MJO DERMAL RESCUE INC
Entity Type:Organization
Organization Name:MJO DERMAL RESCUE INC
Other - Org Name:OUR LITTLE SECRET AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:OLDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:248-804-4323
Mailing Address - Street 1:4181 WINDMILL FARMS
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48380-4279
Mailing Address - Country:US
Mailing Address - Phone:248-804-4323
Mailing Address - Fax:
Practice Address - Street 1:4181 WINDMILL FARMS
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48380-4279
Practice Address - Country:US
Practice Address - Phone:248-804-4323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty