Provider Demographics
NPI:1689253437
Name:DAZETRIN SERVICES LLC
Entity Type:Organization
Organization Name:DAZETRIN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHIDIOGO
Authorized Official - Middle Name:
Authorized Official - Last Name:EBENMELU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-869-2923
Mailing Address - Street 1:6706 LAGUNA TRACE ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2066
Mailing Address - Country:US
Mailing Address - Phone:347-869-2923
Mailing Address - Fax:
Practice Address - Street 1:6706 LAGUNA TRACE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2066
Practice Address - Country:US
Practice Address - Phone:347-869-2923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health