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General NPI Number Information
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NPI Number | 1245628197
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Entity Type | Organization
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Legal Business Name | CJM HOLDINGS LLC
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 4111 KISMET DR
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City | DURHAM
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State | NC
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Zip | 27705-2838
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Country | US
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Telephone | 919-632-2706
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Fax |
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Provider Business Mailing Address
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Address Line | 1802 ATTERBURY LN
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City | DURHAM
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State | NC
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Zip | 27712-2615
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Country | US
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Telephone | 919-294-9946
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | LARRY CAMP
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Credential |
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Telephone | 919-632-2706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL032139
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License Number State | NC
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