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General NPI Number Information
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NPI Number | 1881344281
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Entity Type | Organization
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Legal Business Name | DOMINGUEZ DEVELOPMENT GROUP INCORPORATED
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 72 S LA GRANGE RD STE 9
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City | LA GRANGE
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State | IL
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Zip | 60525-6318
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Country | US
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Telephone | 708-832-4042
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Fax | 708-854-6038
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Provider Business Mailing Address
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Address Line | 72 S LA GRANGE RD STE 9
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City | LA GRANGE
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State | IL
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Zip | 60525-6318
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Country | US
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Telephone | 708-832-4042
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Fax | 708-854-6038
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Authorized Official
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Title or Position | CO-OWNER/ADMINISTRATOR
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Name | MRS. JACQUELINE HERMENCIA DOMINGUEZ
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Credential | RN, BSN
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Telephone | 708-244-9225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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