MEDICARE: DJLW HEALTH SERVICES INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier	20001304	AZ

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	:	1821090390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DJLW HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	3118 N 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4107
Country	:	US
Telephone Number	:	480-656-9177
Fax Number	:	866-401-1401

Provider Business Practice Location Address
First Line	:	3118 N 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4107
Country	:	US
Telephone Number	:	480-656-9177
Fax Number	:	866-401-1401

Authorized Official
Title or Position	:	COO
Name	:	COLLEEN WHEELER
Credential	:
Telephone Number	:	480-656-9177

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/20/2024

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