Provider Demographics
NPI:1043614852
Name:D & J HOME CARE, INC.
Entity Type:Organization
Organization Name:D & J HOME CARE, INC.
Other - Org Name:WADHAMS CREEK SENIOR COMMUNITY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-383-4404
Mailing Address - Street 1:5485 SMITHS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-3811
Mailing Address - Country:US
Mailing Address - Phone:810-367-7192
Mailing Address - Fax:810-367-4308
Practice Address - Street 1:5485 SMITHS CREEK RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-3811
Practice Address - Country:US
Practice Address - Phone:810-367-7192
Practice Address - Fax:810-367-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL7403047923104A0630X
MIAS7403080183104A0630X
MIAS7402991473104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances