MEDICARE: DEJIA HOME HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063895605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEJIA HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	7850 W APPLETON AVE STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5309
Country	:	US
Telephone Number	:	414-585-0766
Fax Number	:	866-500-8896

Provider Business Practice Location Address
First Line	:	7850 W APPLETON AVE STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5309
Country	:	US
Telephone Number	:	414-585-0766
Fax Number	:	866-500-8896

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LEE P. THAO
Credential	:	MS
Telephone Number	:	414-585-0766

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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Directions to “DEJIA HOME HEALTH CARE ” Practice Location

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