Provider Demographics
NPI:1598809824
Name:MJA ENTERPRISES INC.
Entity Type:Organization
Organization Name:MJA ENTERPRISES INC.
Other - Org Name:COMFORCARE HOME CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:CSA, MBA
Authorized Official - Phone:704-543-0630
Mailing Address - Street 1:7215 PINEVILLE-MATTHEWS RD.,
Mailing Address - Street 2:200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-6174
Mailing Address - Country:US
Mailing Address - Phone:704-543-0630
Mailing Address - Fax:704-543-0560
Practice Address - Street 1:7215 PINEVILLE-MATTHEWS RD.,
Practice Address - Street 2:200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-6174
Practice Address - Country:US
Practice Address - Phone:704-543-0630
Practice Address - Fax:704-543-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3375251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418126OtherCAP
NC6601495Medicaid