=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104552629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MJ HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2022
-----------------------------------------------------
Last Update Date | 07/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 384 TRENTON AVE APT 3A
-----------------------------------------------------
City | PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07503-1044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-580-3750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 384 TRENTON AVE APT 3A
-----------------------------------------------------
City | PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07503-1044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-580-3750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MARIO JAMES PASSAFIUME
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-580-3750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------