Healthcare Provider Details

I. General information

NPI: 1710044748
Provider Name (Legal Business Name): LJS DISTRIBUTORS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 JUDGES RD STE 8F
WILMINGTON NC
28405-3645
US

IV. Provider business mailing address

311 JUDGES RD STE 8F
WILMINGTON NC
28405-3645
US

V. Phone/Fax

Practice location:
  • Phone: 910-395-5718
  • Fax: 910-395-5720
Mailing address:
  • Phone: 910-395-5718
  • Fax: 910-395-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3516
License Number StateNC

VIII. Authorized Official

Name: MR. STEVEN DALE MARCUM
Title or Position: PRESIDENT
Credential:
Phone: 910-395-5718