Healthcare Provider Details

I. General information

NPI: 1174461289
Provider Name (Legal Business Name): MJR COMMUNITY SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HUDSON ST
JERSEY CITY NJ
07302-3915
US

IV. Provider business mailing address

101 HUDSON ST
JERSEY CITY NJ
07302-3915
US

V. Phone/Fax

Practice location:
  • Phone: 678-789-9435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CLARISSE KEHOU
Title or Position: CEO
Credential:
Phone: 678-789-9435