Provider Demographics
NPI:1417900085
Name:CJ'S HOMECARE INC.
Entity Type:Organization
Organization Name:CJ'S HOMECARE INC.
Other - Org Name:CJ'S ABUNDANT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROYLN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-378-4600
Mailing Address - Street 1:1002 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1736
Mailing Address - Country:US
Mailing Address - Phone:765-378-4600
Mailing Address - Fax:765-378-4600
Practice Address - Street 1:1002 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1736
Practice Address - Country:US
Practice Address - Phone:765-378-4600
Practice Address - Fax:765-378-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-004091251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200523280AMedicaid
IN000000352484OtherANTHEM BC/BS