Provider Demographics
NPI:1700126315
Name:DEJAY'S ADULT CARE LLC
Entity Type:Organization
Organization Name:DEJAY'S ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AUTHEIL
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:FRECKLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-792-4874
Mailing Address - Street 1:700 NW 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1706
Mailing Address - Country:US
Mailing Address - Phone:954-792-4874
Mailing Address - Fax:954-792-4874
Practice Address - Street 1:700 NW 65TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1706
Practice Address - Country:US
Practice Address - Phone:954-792-4874
Practice Address - Fax:954-792-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906123311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home