Provider Demographics
NPI:1801237557
Name:PJ'S PRIMARY CARE CENTER, INC.
Entity type:Organization
Organization Name:PJ'S PRIMARY CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:606-679-9009
Mailing Address - Street 1:327 CLIFTY ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1666
Mailing Address - Country:US
Mailing Address - Phone:606-679-9009
Mailing Address - Fax:606-678-9883
Practice Address - Street 1:327 CLIFTY ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1666
Practice Address - Country:US
Practice Address - Phone:606-679-9009
Practice Address - Fax:606-678-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services