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General NPI Number Information
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NPI Number | 1427712355
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Entity Type | Organization
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Legal Business Name | CJW LIFE CARE LLC
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 312 CARDINAL DR
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City | CHARLOTTE COURT HOUSE
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State | VA
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Zip | 23923-3789
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Country | US
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Telephone | 434-390-9335
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 573
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City | CHARLOTTE COURT HOUSE
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State | VA
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Zip | 23923-0573
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Country | US
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Telephone | 434-390-9335
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | CARMALITA GENAY ESCOTO
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Credential |
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Telephone | 434-390-9335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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