Provider Demographics
NPI:1659512721
Name:MCJ HOMEMAKER AND COMPANION SERVICES LLC
Entity Type:Organization
Organization Name:MCJ HOMEMAKER AND COMPANION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA DEL CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-547-9454
Mailing Address - Street 1:12355 SW 259TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7073
Mailing Address - Country:US
Mailing Address - Phone:786-547-9454
Mailing Address - Fax:305-245-0980
Practice Address - Street 1:14434 SW 293RD TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2953
Practice Address - Country:US
Practice Address - Phone:786-547-9454
Practice Address - Fax:305-245-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL07000062435310400000X, 385H00000X, 385HR2060X, 385HR2065X
FLL07000062465311ZA0620X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child