Healthcare Provider Details

I. General information

NPI: 1376131854
Provider Name (Legal Business Name): C&J PROVIDER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2021
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 METRIC DR
MENTOR OH
44060-4862
US

IV. Provider business mailing address

7770 METRIC DR
MENTOR OH
44060-4862
US

V. Phone/Fax

Practice location:
  • Phone: 216-798-9231
  • Fax:
Mailing address:
  • Phone: 216-798-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: REEVE CARRIERO
Title or Position: OWNER
Credential:
Phone: 216-798-9231