Provider Demographics
NPI:1235450875
Name:PBAJ ENTERPRISES, INC.
Entity Type:Organization
Organization Name:PBAJ ENTERPRISES, INC.
Other - Org Name:COMFORCARE SENIOR SERVICES - NORTHERN LEE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-333-9883
Mailing Address - Street 1:608 SE 29TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-3527
Mailing Address - Country:US
Mailing Address - Phone:239-458-9423
Mailing Address - Fax:239-471-7914
Practice Address - Street 1:1406 SE 46TH LN
Practice Address - Street 2:SUITE 6
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8684
Practice Address - Country:US
Practice Address - Phone:239-471-7920
Practice Address - Fax:239-471-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231752251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health