Healthcare Provider Details

I. General information

NPI: 1871357780
Provider Name (Legal Business Name): DRIGUS ADVENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MINERAL CT
DOVER DE
19904-3704
US

IV. Provider business mailing address

6606 W HAYES ST
PHOENIX AZ
85043-5078
US

V. Phone/Fax

Practice location:
  • Phone: 302-922-0142
  • Fax:
Mailing address:
  • Phone: 302-922-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ROMONA LOVE BROWN
Title or Position: ADMINISTRATOR
Credential:
Phone: 302-922-0142