Healthcare Provider Details

I. General information

NPI: 1679025886
Provider Name (Legal Business Name): DDJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 11TH AVE S STE 528
BIRMINGHAM AL
35205-2816
US

IV. Provider business mailing address

2112 11TH AVE S STE 528
BIRMINGHAM AL
35205-2816
US

V. Phone/Fax

Practice location:
  • Phone: 205-390-1999
  • Fax:
Mailing address:
  • Phone: 205-390-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CASEY SHEHI
Title or Position: DIRECTOR BUSINESS DEVELOPMENT
Credential:
Phone: 205-390-1999