Provider Demographics
NPI:1063895605
Name:DEJIA HOME HEALTH CARE
Entity type:Organization
Organization Name:DEJIA HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:P
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:414-585-0766
Mailing Address - Street 1:7850 W APPLETON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5309
Mailing Address - Country:US
Mailing Address - Phone:414-585-0766
Mailing Address - Fax:866-500-8896
Practice Address - Street 1:7850 W APPLETON AVE STE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5309
Practice Address - Country:US
Practice Address - Phone:414-585-0766
Practice Address - Fax:866-500-8896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100043557Medicaid