Healthcare Provider Details

I. General information

NPI: 1598405532
Provider Name (Legal Business Name): CTJ FOOD SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E GILBREATH ST
GRAHAM NC
27253-3747
US

IV. Provider business mailing address

611 E GILBREATH ST
GRAHAM NC
27253-3747
US

V. Phone/Fax

Practice location:
  • Phone: 336-437-0393
  • Fax:
Mailing address:
  • Phone: 336-437-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. CARLOS A GARCIA
Title or Position: PRODUCTION & SALES MANAGER
Credential:
Phone: 53-773-5141