Healthcare Provider Details

I. General information

NPI: 1477001766
Provider Name (Legal Business Name): DJJE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 W BRYN MAWR AVE STE 204
CHICAGO IL
60631
US

IV. Provider business mailing address

8609 W BRYN MAWR AVE STE 204
CHICAGO IL
60631-3524
US

V. Phone/Fax

Practice location:
  • Phone: 224-436-0788
  • Fax: 224-241-3132
Mailing address:
  • Phone: 224-436-0788
  • Fax: 224-241-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LLUVIA MARQUEZ
Title or Position: DIRECTOR OF BILLING DEPARTMENT
Credential:
Phone: 773-644-7787