Provider Demographics
NPI:1285220145
Name:CJW HEALTHCARE
Entity Type:Organization
Organization Name:CJW HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:VILLAR
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:SR
Authorized Official - Credentials:N/A
Authorized Official - Phone:079-036-1699
Mailing Address - Street 1:3201 W 28TH CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1620
Mailing Address - Country:US
Mailing Address - Phone:907-644-3044
Mailing Address - Fax:907-644-3044
Practice Address - Street 1:343 EGAVIK DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7334
Practice Address - Country:US
Practice Address - Phone:907-644-3044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility