Provider Demographics
NPI:1366743361
Name:JERMON & DIEGO HOMES
Entity type:Organization
Organization Name:JERMON & DIEGO HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEVISHA
Authorized Official - Middle Name:CHEVELLE
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:CNA,EKG,HHA,MEDICAL
Authorized Official - Phone:1800-503-9702
Mailing Address - Street 1:1208 50TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4011
Mailing Address - Country:US
Mailing Address - Phone:800-503-9702
Mailing Address - Fax:202-388-0729
Practice Address - Street 1:1208 50TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4011
Practice Address - Country:US
Practice Address - Phone:800-503-9702
Practice Address - Fax:202-388-0729
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:4 HEAVEN'S SAKE HOMECARE & TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities