Healthcare Provider Details

I. General information

NPI: 1194632646
Provider Name (Legal Business Name): MR. TRAVIS LEE DEJOHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 BELMONT AVE NE
BELMONT MI
49306-9714
US

IV. Provider business mailing address

7685 BELMONT AVE NE
BELMONT MI
49306-9714
US

V. Phone/Fax

Practice location:
  • Phone: 616-799-0006
  • Fax:
Mailing address:
  • Phone: 616-799-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: