Provider Demographics
NPI:1881344281
Name:DOMINGUEZ DEVELOPMENT GROUP INCORPORATED
Entity type:Organization
Organization Name:DOMINGUEZ DEVELOPMENT GROUP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:HERMENCIA
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:708-244-9225
Mailing Address - Street 1:72 S LA GRANGE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6318
Mailing Address - Country:US
Mailing Address - Phone:708-832-4042
Mailing Address - Fax:708-854-6038
Practice Address - Street 1:72 S LA GRANGE RD STE 9
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6318
Practice Address - Country:US
Practice Address - Phone:708-832-4042
Practice Address - Fax:708-854-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No385H00000XRespite Care FacilityRespite Care