MEDICARE: CJ- N ACTION HOME HEALTH SERVICES 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1548895725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CJ- N ACTION HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	12556 CHARDIN PL APT 3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2126
Country	:	US
Telephone Number	:	314-596-8828
Fax Number	:

Provider Business Practice Location Address
First Line	:	12556 CHARDIN PL APT 3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2126
Country	:	US
Telephone Number	:	314-596-8828
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CARLA ANN JORDAN
Credential	:
Telephone Number	:	314-596-8828

Provider Enumeration Date	:	03/07/2020
Last Update Date	:	03/07/2020

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