Healthcare Provider Details

I. General information

NPI: 1215276019
Provider Name (Legal Business Name): CLJ HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 PARK PL. 4C
BROOKLYN NY
11213
US

IV. Provider business mailing address

985 PARK PL. 4C
BROOKLYN NY
11213
US

V. Phone/Fax

Practice location:
  • Phone: 347-300-5844
  • Fax: 347-772-3423
Mailing address:
  • Phone: 347-300-5844
  • Fax: 347-772-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: IRENE CORTES
Title or Position: CEO/FOUNDER
Credential:
Phone: 347-300-5844