MEDICARE: CJ'S HOME CARE 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1114544467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CJ'S HOME CARE LLC

Provider Business Mailing Address
First Line	:	6034 CHESTER AVE STE 105A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2237
Country	:	US
Telephone Number	:	904-307-3895
Fax Number	:

Provider Business Practice Location Address
First Line	:	6034 CHESTER AVE STE 105A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2237
Country	:	US
Telephone Number	:	904-307-3895
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CURLINE JACKSON-DARDEN
Credential	:
Telephone Number	:	904-723-1314

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	08/04/2020

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Directions to “CJ'S HOME CARE LLC ” Practice Location

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