Healthcare Provider Details

I. General information

NPI: 1205401577
Provider Name (Legal Business Name): CJB HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 W 10TH ST
NEWPORT KY
41071-1444
US

IV. Provider business mailing address

7926 CALEDONIA CT
ALEXANDRIA KY
41001-1469
US

V. Phone/Fax

Practice location:
  • Phone: 859-620-5935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER BUSH
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 859-620-5935