Provider Demographics
NPI:1598455321
Name:CCJ ONLINE HOLDINGS, LLC
Entity Type:Organization
Organization Name:CCJ ONLINE HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-981-2007
Mailing Address - Street 1:7932 GILMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2708
Mailing Address - Country:US
Mailing Address - Phone:410-929-9456
Mailing Address - Fax:
Practice Address - Street 1:7932 GILMORE AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2708
Practice Address - Country:US
Practice Address - Phone:410-929-9456
Practice Address - Fax:443-982-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility