MEDICARE: DEJA'S LOVING HANDS HOMECARE LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1568030948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEJA'S LOVING HANDS HOMECARE LLC

Provider Business Mailing Address
First Line	:	3525 OMAHA AVE
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-1534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 OMAHA AVE
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-1534
Country	:	US
Telephone Number	:	440-233-9927
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT/ADMINISTRATOR
Name	:	DEJA JACKSON
Credential	:
Telephone Number	:	440-233-9927

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/14/2021

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