Healthcare Provider Details

I. General information

NPI: 1235930058
Provider Name (Legal Business Name): DAAH PRESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 RAVINE ST
JANESVILLE WI
53548-3451
US

IV. Provider business mailing address

2047 RAVINE ST
JANESVILLE WI
53548-3451
US

V. Phone/Fax

Practice location:
  • Phone: 608-905-1332
  • Fax:
Mailing address:
  • Phone: 608-905-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DAAH H MOHAMED
Title or Position: OWNER/OPERATOR
Credential:
Phone: 608-905-1332