Provider Demographics
NPI:1568474161
Name:CD&J MANAGEMENT, LLC
Entity Type:Organization
Organization Name:CD&J MANAGEMENT, LLC
Other - Org Name:OPTIMUM PERSONAL CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELILAH
Authorized Official - Middle Name:MOUTON
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-593-8444
Mailing Address - Street 1:920 W PINHOOK RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2455
Mailing Address - Country:US
Mailing Address - Phone:337-593-8444
Mailing Address - Fax:337-593-9966
Practice Address - Street 1:920 W PINHOOK RD
Practice Address - Street 2:SUITE 226
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2455
Practice Address - Country:US
Practice Address - Phone:337-593-8444
Practice Address - Fax:337-593-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11117305R00000X
LA12067305R00000X
LA12068305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1778371Medicaid
LA1776785Medicaid
LA1466093Medicaid