Provider Demographics
NPI:1154861961
Name:CLJ HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CLJ HOME HEALTHCARE, LLC
Other - Org Name:AFFINITY PEDIATRIC HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-310-9733
Mailing Address - Street 1:1600 NE LOOP 410 STE 104A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1612
Mailing Address - Country:US
Mailing Address - Phone:210-824-1140
Mailing Address - Fax:210-824-1170
Practice Address - Street 1:1600 NE LOOP 410 STE 104A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1612
Practice Address - Country:US
Practice Address - Phone:210-824-1140
Practice Address - Fax:210-824-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX373537501Medicaid