Provider Demographics
NPI:1104675339
Name:BROOMES, DEAIRR JAMEKIA
Entity type:Individual
Prefix:
First Name:DEAIRR
Middle Name:JAMEKIA
Last Name:BROOMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 E MCMILLAN ST APT 217
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-3510
Mailing Address - Country:US
Mailing Address - Phone:513-814-7775
Mailing Address - Fax:
Practice Address - Street 1:929 E MCMILLAN ST APT 217
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-3510
Practice Address - Country:US
Practice Address - Phone:513-814-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities