Provider Demographics
NPI:1518627413
Name:DLJ HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:DLJ HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWANA
Authorized Official - Middle Name:CHANITA-LATRICE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-755-5050
Mailing Address - Street 1:1000 AMITY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3711
Mailing Address - Country:US
Mailing Address - Phone:704-755-5050
Mailing Address - Fax:
Practice Address - Street 1:1000 AMITY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3711
Practice Address - Country:US
Practice Address - Phone:704-755-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health