Provider Demographics
NPI:1821090390
Name:DJLW HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:DJLW HEALTH SERVICES INC.
Other - Org Name:MCCLEVE ORTHOTICS & PROSTHETICS
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-656-9177
Mailing Address - Street 1:3118 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4107
Mailing Address - Country:US
Mailing Address - Phone:480-656-9177
Mailing Address - Fax:866-401-1401
Practice Address - Street 1:3118 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4107
Practice Address - Country:US
Practice Address - Phone:480-656-9177
Practice Address - Fax:866-401-1401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHEELER MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-12
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AZ20001304335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ847048Medicaid