=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427995026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CJ HOME CARE INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2026
-----------------------------------------------------
Last Update Date | 05/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 N TRYON ST STE 1600
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28202-0213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-421-8335
-----------------------------------------------------
Fax | 980-522-2050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 N TRYON ST STE 1600
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28202-0213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-421-8335
-----------------------------------------------------
Fax | 980-522-2050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. OKEIKHAN JOHN EDOBOR JOHN EDOBOR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 404-421-8335
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------