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General NPI Number Information
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NPI Number | 1821356304
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Entity Type | Organization
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Legal Business Name | TJ HOUSING, LLC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 3031 SCOTSMAN RD SUITE 5&6
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City | COLUMBIA
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State | SC
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Zip | 29223-1812
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Country | US
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Telephone | 803-661-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 8 SLEEPY HOLLOW LN
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City | HOPKINS
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State | SC
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Zip | 29061-9627
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Country | US
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Telephone | 803-661-0110
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOE JACKSON SR.
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Credential |
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Telephone | 803-446-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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