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General NPI Number Information
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NPI Number | 1295403137
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Entity Type | Organization
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Legal Business Name | CCJ ADULT CARE II LLC
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 112 PONY BARN RD
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City | LAWNDALE
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State | NC
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Zip | 28090-9466
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Country | US
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Telephone | 704-538-8026
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Fax | 704-671-2192
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Provider Business Mailing Address
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Address Line | PO BOX 74
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City | BESSEMER CITY
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State | NC
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Zip | 28016-0074
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Country | US
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Telephone | 980-295-3020
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/OPERATOR
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Name | BERNICE R HOSCH
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Credential |
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Telephone | 980-295-3020
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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 |
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License Number State |
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