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General NPI Number Information
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NPI Number | 1790208130
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Entity Type | Organization
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Legal Business Name | CSJ ENTERPRISE, LLC
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 7187 CAMINO DEGRAZIA UNIT 87
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City | SAN DIEGO
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State | CA
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Zip | 92111-7837
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Country | US
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Telephone | 858-280-4500
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Fax | 858-368-6734
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Provider Business Mailing Address
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Address Line | 2307 FENTON PKWY STE 107-252
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City | SAN DIEGO
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State | CA
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Zip | 92108-4746
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Country | US
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Telephone | 858-280-4500
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Fax | 858-368-6734
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES SHEROD JOHNSON
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Credential |
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Telephone | 858-280-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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