Provider Demographics
NPI:1508052192
Name:CJT ENTERPRISES, INC.
Entity Type:Organization
Organization Name:CJT ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:SOHRT
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-751-6295
Mailing Address - Street 1:17870 NEWHOPE ST UNIT 104-457
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5439
Mailing Address - Country:US
Mailing Address - Phone:714-751-6295
Mailing Address - Fax:
Practice Address - Street 1:11661 MARTENS RIVER CIR STE C
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4212
Practice Address - Country:US
Practice Address - Phone:714-751-6295
Practice Address - Fax:714-751-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ368177Medicaid