Provider Demographics
NPI:1437384369
Name:DEJUS LLC
Entity Type:Organization
Organization Name:DEJUS LLC
Other - Org Name:PA'LLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAZIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL ASSISTANT
Authorized Official - Phone:817-293-2754
Mailing Address - Street 1:7801 MARLBOROUGH DR W
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-4309
Mailing Address - Country:US
Mailing Address - Phone:817-293-2754
Mailing Address - Fax:817-230-4938
Practice Address - Street 1:7801 MARLBOROUGH DR W
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-4309
Practice Address - Country:US
Practice Address - Phone:817-293-2754
Practice Address - Fax:817-230-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility