Healthcare Provider Details

I. General information

NPI: 1053041624
Provider Name (Legal Business Name): DJC ROCK PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S WATSON RD # 114-562
BUCKEYE AZ
85326-6303
US

IV. Provider business mailing address

1300 S WATSON RD # 114-562
BUCKEYE AZ
85326-6303
US

V. Phone/Fax

Practice location:
  • Phone: 480-442-7365
  • Fax:
Mailing address:
  • Phone:
  • 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: JUDITH CARTER
Title or Position: OWNER
Credential:
Phone: 480-442-7365