Provider Demographics
NPI:1326890427
Name:TJ&M SPECIALTY SERVICES LLC
Entity Type:Organization
Organization Name:TJ&M SPECIALTY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEQUATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSHENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-253-6325
Mailing Address - Street 1:333 E VERNA ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4621
Mailing Address - Country:US
Mailing Address - Phone:225-253-4889
Mailing Address - Fax:
Practice Address - Street 1:10646 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-7913
Practice Address - Country:US
Practice Address - Phone:225-283-4020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health