Provider Demographics
NPI:1184087546
Name:ARJ SC
Entity type:Organization
Organization Name:ARJ SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-229-3788
Mailing Address - Street 1:1100 S MINT ST STE 107
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4058
Mailing Address - Country:US
Mailing Address - Phone:980-819-5692
Mailing Address - Fax:980-819-5694
Practice Address - Street 1:1100 S MINT ST STE 107
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4058
Practice Address - Country:US
Practice Address - Phone:980-819-5692
Practice Address - Fax:980-819-5694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARJ, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCM1047Medicaid