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General NPI Number Information
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NPI Number | 1053911479
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Entity Type | Individual
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Provider Name | DEMITRIUS BRACKETT OWNER/DO
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Gender | Male
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 411 N BLUFF ST APT 11
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City | JOLIET
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State | IL
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Zip | 60435-7295
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Country | US
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Telephone | 815-766-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 311 N OTTAWA ST APT 209
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City | JOLIET
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State | IL
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Zip | 60432-4080
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Country | US
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Telephone | 815-766-5999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | AZ
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