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General NPI Number Information
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NPI Number | 1174461289
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Entity Type | Organization
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Legal Business Name | MJR COMMUNITY SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 101 HUDSON ST
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3915
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Country | US
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Telephone | 678-789-9435
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Fax |
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Provider Business Mailing Address
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Address Line | 101 HUDSON ST
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3915
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CLARISSE KEHOU
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Credential |
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Telephone | 678-789-9435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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