Healthcare Provider Details

I. General information

NPI: 1699695122
Provider Name (Legal Business Name): MTJ CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 BLUE RIDGE DR APT G
BLACKSBURG VA
24060-8010
US

IV. Provider business mailing address

10700 BLUE RIDGE DR APT G
BLACKSBURG VA
24060-8010
US

V. Phone/Fax

Practice location:
  • Phone: 804-216-1079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. AMANAT ALI
Title or Position: DIRECTOR
Credential:
Phone: 804-216-1079