Provider Demographics
NPI:1467065920
Name:DAMOSTAMAZING LLC
Entity Type:Organization
Organization Name:DAMOSTAMAZING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAKINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JULY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-386-1347
Mailing Address - Street 1:112 MCLEOD ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30453-4260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-3009
Practice Address - Country:US
Practice Address - Phone:912-386-1347
Practice Address - Fax:912-386-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care