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General NPI Number Information
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NPI Number | 1235509522
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Entity Type | Organization
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Legal Business Name | D & J HOMECARE LLC
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 1345 CHEROKEE RD
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City | INMAN
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State | KS
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Zip | 67546-8086
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Country | US
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Telephone | 620-585-6908
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Fax | 620-585-6930
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Provider Business Mailing Address
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Address Line | 1345 CHEROKEE RD
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City | INMAN
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State | KS
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Zip | 67546-8086
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Country | US
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Telephone | 620-585-6908
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Fax | 620-585-6930
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Authorized Official
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Title or Position | DON / OWNER
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Name | DAWNELLE ADCOCK
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Credential | R.N.
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Telephone | 620-241-1074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | B059012
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | B059012
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License Number State | KS
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