Healthcare Provider Details

I. General information

NPI: 1285867622
Provider Name (Legal Business Name): DJC HOME HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 ANNAPOLIS RD SUITE 106
ODENTON MD
21113-1216
US

IV. Provider business mailing address

P. O. BOX 307
ODENTON MD
21113-1207
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-8906
  • Fax: 410-672-8908
Mailing address:
  • Phone: 410-672-8906
  • Fax: 410-672-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR2782
License Number StateMD

VIII. Authorized Official

Name: MRS. BRENDA DENISE POPE
Title or Position: PRESIDENT
Credential: MT(ASCP)
Phone: 410-672-8906