Provider Demographics
NPI:1477876423
Name:CJW ENTERPRISES, INC.
Entity Type:Organization
Organization Name:CJW ENTERPRISES, INC.
Other - Org Name:INNOVARE HEALTH ADVOCATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-843-4794
Mailing Address - Street 1:9915 KENNERLY RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2703
Mailing Address - Country:US
Mailing Address - Phone:314-843-4794
Mailing Address - Fax:314-843-9256
Practice Address - Street 1:9915 KENNERLY RD
Practice Address - Street 2:SUITE J
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2703
Practice Address - Country:US
Practice Address - Phone:314-843-4794
Practice Address - Fax:314-843-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty