Provider Demographics
NPI:1245364686
Name:D J MONTGOMERY ENTERPRISE, LLC
Entity type:Organization
Organization Name:D J MONTGOMERY ENTERPRISE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:972-459-9264
Mailing Address - Street 1:860 HEBRON PKWY
Mailing Address - Street 2:SUITE 703 & 704
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5151
Mailing Address - Country:US
Mailing Address - Phone:972-459-9264
Mailing Address - Fax:214-260-1140
Practice Address - Street 1:860 HEBRON PKWY
Practice Address - Street 2:SUITE 703 & 704
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5151
Practice Address - Country:US
Practice Address - Phone:972-459-9264
Practice Address - Fax:214-260-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009728251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677946Medicare ID - Type UnspecifiedPROVIDER NUMBER