Provider Demographics
NPI:1922524834
Name:DJK HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:DJK HOME HEALTHCARE, LLC
Other - Org Name:CHILDREN'S HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HADFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-244-2757
Mailing Address - Street 1:901 WATERFALL WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6753
Mailing Address - Country:US
Mailing Address - Phone:972-661-3737
Mailing Address - Fax:972-661-3721
Practice Address - Street 1:4600 A MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE A-101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1218
Practice Address - Country:US
Practice Address - Phone:505-881-0054
Practice Address - Fax:808-551-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251E00000X, 251J00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34102256Medicaid