Provider Demographics
NPI:1063438364
Name:DJK HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:DJK HOME HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-482-9020
Mailing Address - Street 1:901 WATERFALL WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6700
Mailing Address - Country:US
Mailing Address - Phone:972-661-3737
Mailing Address - Fax:903-482-9019
Practice Address - Street 1:293 W VAN ALSTYNE PKWY
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-4379
Practice Address - Country:US
Practice Address - Phone:903-482-9020
Practice Address - Fax:903-482-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9937251J00000X
TX009937253Z00000X, 385H00000X, 251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177176801OtherTPI NUMBER FOR TMHP
TX177176802OtherTPI
TX177176803Medicaid
TX009937Medicaid