Provider Demographics
NPI:1649393828
Name:BJ PROFESSIONAL SERVICES INC
Entity Type:Organization
Organization Name:BJ PROFESSIONAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TWYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-862-2484
Mailing Address - Street 1:1206 TWISTED HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-5216
Mailing Address - Country:US
Mailing Address - Phone:910-862-2484
Mailing Address - Fax:
Practice Address - Street 1:1206 TWISTED HICKORY RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-5216
Practice Address - Country:US
Practice Address - Phone:910-862-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6600532376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600532Medicaid