Provider Demographics
NPI:1881737914
Name:CJMG HOLDINGS, LLC
Entity type:Organization
Organization Name:CJMG HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:ZAFFATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-673-8222
Mailing Address - Street 1:2620 CENTENARY BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104
Mailing Address - Country:US
Mailing Address - Phone:318-673-8222
Mailing Address - Fax:318-673-8223
Practice Address - Street 1:2620 CENTENARY BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-673-8222
Practice Address - Fax:318-673-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1024961Medicaid
LA5977420001Medicare NSC