1063438364 NPI number — DJK HOME HEALTHCARE, LLC

Table of content: (NPI 1063438364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063438364 NPI number — DJK HOME HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DJK HOME HEALTHCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHILDREN'S HOME HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063438364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 WATERFALL WAY
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75080-6700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-661-3737
Provider Business Mailing Address Fax Number:
903-482-9019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
293 W VAN ALSTYNE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN ALSTYNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75495-4379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-482-9020
Provider Business Practice Location Address Fax Number:
903-482-9019
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
903-482-9020

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  009937 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: 9937 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 009937 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: 009937 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 177176801 . This is a "TPI NUMBER FOR TMHP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 009937 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177176802 . This is a "TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 177176803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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