=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326354051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D & D HEALTH SYSTEM, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2010
-----------------------------------------------------
Last Update Date | 09/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8634 W BROWN DEER RD SUITE 102
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53224-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-354-5540
-----------------------------------------------------
Fax | 414-354-5530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8634 W BROWN DEER RD SUITE 102
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53224-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-354-5540
-----------------------------------------------------
Fax | 414-354-5530
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. DARIUS HARRIS SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-291-8485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------