Provider Demographics
NPI:1790208130
Name:CSJ ENTERPRISE, LLC
Entity Type:Organization
Organization Name:CSJ ENTERPRISE, LLC
Other - Org Name:UNLIMITED CARE SD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SHEROD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-280-4500
Mailing Address - Street 1:2307 FENTON PKWY STE 107-252
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4746
Mailing Address - Country:US
Mailing Address - Phone:858-280-4500
Mailing Address - Fax:858-368-6734
Practice Address - Street 1:7187 CAMINO DEGRAZIA UNIT 87
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-7837
Practice Address - Country:US
Practice Address - Phone:858-280-4500
Practice Address - Fax:858-368-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care