Healthcare Provider Details

I. General information

NPI: 1235509522
Provider Name (Legal Business Name): D & J HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 CHEROKEE RD
INMAN KS
67546-8086
US

IV. Provider business mailing address

1345 CHEROKEE RD
INMAN KS
67546-8086
US

V. Phone/Fax

Practice location:
  • Phone: 620-585-6908
  • Fax: 620-585-6930
Mailing address:
  • Phone: 620-585-6908
  • Fax: 620-585-6930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberB059012
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberB059012
License Number StateKS

VIII. Authorized Official

Name: DAWNELLE ADCOCK
Title or Position: DON / OWNER
Credential: R.N.
Phone: 620-241-1074