MEDICARE: TJT FAMILY HOME

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	320700000X	Physical Disabilities Residential Treatment Facility
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1144760844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TJT FAMILY HOME

Provider Business Mailing Address
First Line	:	116 LEANNE DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-8126
Country	:	US
Telephone Number	:	252-341-1082
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 LEANNE DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-8126
Country	:	US
Telephone Number	:	252-341-1082
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MS. TAWANA SALES
Credential	:
Telephone Number	:	252-341-1082

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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Directions to “TJT FAMILY HOME ” Practice Location

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