Provider Demographics
NPI:1144259243
Name:DKJK, INC
Entity type:Organization
Organization Name:DKJK, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KNOBLAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-994-7277
Mailing Address - Street 1:1424 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4004
Mailing Address - Country:US
Mailing Address - Phone:361-994-7277
Mailing Address - Fax:361-994-7999
Practice Address - Street 1:1424 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4004
Practice Address - Country:US
Practice Address - Phone:361-994-7277
Practice Address - Fax:361-994-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009070251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1=========1000OtherTIN