Provider Demographics
NPI:1376131854
Name:C&J PROVIDER SERVICES
Entity Type:Organization
Organization Name:C&J PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-798-9231
Mailing Address - Street 1:7770 METRIC DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4862
Mailing Address - Country:US
Mailing Address - Phone:216-798-9231
Mailing Address - Fax:
Practice Address - Street 1:7770 METRIC DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4862
Practice Address - Country:US
Practice Address - Phone:216-798-9231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle