MEDICARE: LCDJ ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)
2	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1023969904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LCDJ ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	517 VERNON WHITE RD
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-8691
Country	:	US
Telephone Number	:	252-412-7372
Fax Number	:	252-412-7372

Provider Business Practice Location Address
First Line	:	517 VERNON WHITE RD
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-8691
Country	:	US
Telephone Number	:	252-412-7372
Fax Number	:	252-412-7372

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. OLIVE W CHAPMAN
Credential	:
Telephone Number	:	800-691-2290

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “LCDJ ENTERPRISES, LLC ” Practice Location

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