Provider Demographics
NPI:1710014238
Name:DJCRC, INC.
Entity Type:Organization
Organization Name:DJCRC, INC.
Other - Org Name:LIFE MANAGEMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, CRC
Authorized Official - Phone:361-887-1866
Mailing Address - Street 1:801 LIPAN ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-2405
Mailing Address - Country:US
Mailing Address - Phone:361-887-1866
Mailing Address - Fax:361-888-6475
Practice Address - Street 1:801 LIPAN ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2405
Practice Address - Country:US
Practice Address - Phone:361-887-1866
Practice Address - Fax:361-888-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management