Provider Demographics
NPI:1265481378
Name:CJT HOME HEALTH, INC
Entity type:Organization
Organization Name:CJT HOME HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-758-4416
Mailing Address - Street 1:4148 20TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-5001
Mailing Address - Country:US
Mailing Address - Phone:941-758-4416
Mailing Address - Fax:941-755-6167
Practice Address - Street 1:4148 20TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5001
Practice Address - Country:US
Practice Address - Phone:941-758-4416
Practice Address - Fax:941-755-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299991015251E00000X
FLHHA299991999251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687920979Medicaid
FL80250OtherUNITED HEALTHCARE EVERCAR
FL687246801Medicaid
FL687246800Medicaid
FL687246868Medicaid