Provider Demographics
NPI:1568039469
Name:DEMDIJA HOMECARE LLC
Entity Type:Organization
Organization Name:DEMDIJA HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BSN RN
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:929-575-3720
Mailing Address - Street 1:5971 CONGRESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8347
Mailing Address - Country:US
Mailing Address - Phone:929-575-3720
Mailing Address - Fax:
Practice Address - Street 1:5971 CONGRESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8347
Practice Address - Country:US
Practice Address - Phone:929-575-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health