Provider Demographics
NPI:1942605746
Name:D & J HOME CARE 3, LLC
Entity Type:Organization
Organization Name:D & J HOME CARE 3, LLC
Other - Org Name:WADHAMS VALLEY SENIOR COMMUNITY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-383-4404
Mailing Address - Street 1:33255 26 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MI
Mailing Address - Zip Code:48048-2904
Mailing Address - Country:US
Mailing Address - Phone:586-270-6784
Mailing Address - Fax:586-270-6787
Practice Address - Street 1:33255 26 MILE RD
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MI
Practice Address - Zip Code:48048-2904
Practice Address - Country:US
Practice Address - Phone:586-270-6784
Practice Address - Fax:586-270-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM5003099723104A0630X
MIAM5003099653104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances