Healthcare Provider Details

I. General information

NPI: 1134665169
Provider Name (Legal Business Name): D'JANNIC GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2017
Last Update Date: 01/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 STEVENSON BLVD SUITE 304
FREMONT CA
94538-2485
US

IV. Provider business mailing address

7100 STEVENSON BLVD SUITE 304
FREMONT CA
94538-2485
US

V. Phone/Fax

Practice location:
  • Phone: 510-398-7494
  • Fax: 510-398-7495
Mailing address:
  • Phone: 510-398-7494
  • Fax: 510-398-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. JONN MAHATMA DMARTIN
Title or Position: CEO
Credential:
Phone: 925-864-6128