Provider Demographics
NPI:1316287709
Name:DMJA ENTERPRISES LLC
Entity type:Organization
Organization Name:DMJA ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-283-3820
Mailing Address - Street 1:1229 N 23RD ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6568
Mailing Address - Country:US
Mailing Address - Phone:970-283-3820
Mailing Address - Fax:970-245-7481
Practice Address - Street 1:1229 N 23RD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6568
Practice Address - Country:US
Practice Address - Phone:970-283-3820
Practice Address - Fax:970-245-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10H563253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10H563OtherCLASS B LICENSE NUMBER