Provider Demographics
NPI:1881056083
Name:LEJ ENTERPRISES INC
Entity type:Organization
Organization Name:LEJ ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAVONDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-926-9408
Mailing Address - Street 1:1721 TENDERFOOT LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2731
Mailing Address - Country:US
Mailing Address - Phone:469-297-4334
Mailing Address - Fax:
Practice Address - Street 1:1721 TENDERFOOT LN
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2731
Practice Address - Country:US
Practice Address - Phone:469-297-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health