Provider Demographics
NPI:1154532315
Name:DMJ HOME HEALTH SERVICES, INC
Entity type:Organization
Organization Name:DMJ HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-423-2667
Mailing Address - Street 1:2720 E. NEW YORK ST.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502
Mailing Address - Country:US
Mailing Address - Phone:847-423-2667
Mailing Address - Fax:866-253-2315
Practice Address - Street 1:2720 E. NEW YORK ST.
Practice Address - Street 2:SUITE 120
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502
Practice Address - Country:US
Practice Address - Phone:847-423-2667
Practice Address - Fax:866-253-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010732251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011769Medicaid