Healthcare Provider Details

I. General information

NPI: 1114781622
Provider Name (Legal Business Name): T-JA ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5065 SOPRANO CIR
FAIRFIELD CA
94534-6897
US

IV. Provider business mailing address

5065 SOPRANO CIR
FAIRFIELD CA
94534-6897
US

V. Phone/Fax

Practice location:
  • Phone: 707-803-0654
  • Fax: 707-402-6504
Mailing address:
  • Phone: 707-803-0654
  • Fax: 707-402-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ROGIE MALLARI
Title or Position: MANAGING OWNER
Credential: LICENSEE
Phone: 707-803-0654