1942375191 NPI number — DJK HOME HEALTHCARE, LLC

Table of content: (NPI 1942375191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942375191 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:
CHILDRENS 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:
1942375191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1612 S VAN BUREN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79102-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-367-6612
Provider Business Mailing Address Fax Number:
806-367-7148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1612 S VAN BUREN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-367-6612
Provider Business Practice Location Address Fax Number:
806-367-7148
Provider Enumeration Date:
11/22/2006

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:
806-367-6612

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  009669 , 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: 009669 , 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: 009669 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X , with the licence number: 009669 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: 009669 , 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: 172663001 . This is a "TPI NUMBER FOR TMHP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 172663003 . This is a "TPI NUMBER FOR TMHP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 172663005 . This is a "TPI NUMBER FOR TMHP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 009669 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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