Healthcare Provider Details

I. General information

NPI: 1225710346
Provider Name (Legal Business Name): DMJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E STANFORD DR
TEMPE AZ
85283-2432
US

IV. Provider business mailing address

3108 S FAIRWAY DR
TEMPE AZ
85282-4028
US

V. Phone/Fax

Practice location:
  • Phone: 480-201-4102
  • Fax:
Mailing address:
  • Phone: 480-201-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MAX OKUN
Title or Position: VP
Credential:
Phone: 480-201-4102