Provider Demographics
NPI:1154072304
Name:DEZYEVE PROIRITY HOMECARE
Entity Type:Organization
Organization Name:DEZYEVE PROIRITY HOMECARE
Other - Org Name:DEZYEVE PROIRITY HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NKENG
Authorized Official - Middle Name:B
Authorized Official - Last Name:NGWEMOH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:331-980-9016
Mailing Address - Street 1:2514 CALIENDO CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-4015
Mailing Address - Country:US
Mailing Address - Phone:331-980-9016
Mailing Address - Fax:
Practice Address - Street 1:2514 CALIENDO CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-4015
Practice Address - Country:US
Practice Address - Phone:331-980-9016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities