Provider Demographics
NPI:1104205558
Name:CJ HOMECARE INC.
Entity Type:Organization
Organization Name:CJ HOMECARE INC.
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-744-4277
Mailing Address - Street 1:1110 PARK ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 PARK ST
Practice Address - Street 2:SUITE 800
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3614
Practice Address - Country:US
Practice Address - Phone:409-291-4029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care