MEDICARE: CJ HOMECARE, INC.

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

General Provider Information

NPI Number	:	1952715823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CJ HOMECARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 8175
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76714-8175
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6236 N HIGHWAY 146 # 11
Second Line	:
City	:	BAYTOWN
State	:	TX
Zip	:	77523-9081
Country	:	US
Telephone Number	:	832-514-6539
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRENT WILSON
Credential	:
Telephone Number	:	254-744-4277

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	06/18/2014

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Directions to “CJ HOMECARE, INC. ” Practice Location

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