=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174098602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GJ HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2018
-----------------------------------------------------
Last Update Date | 10/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2352 N 7TH ST STE C
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-8168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-208-3985
-----------------------------------------------------
Fax | 970-579-7094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2352 N 7TH ST STE C
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-8168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-208-3985
-----------------------------------------------------
Fax | 970-579-7094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MARTIN THOMAS BOYCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-208-3985
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------