Provider Demographics
NPI:1982774717
Name:LJLMEDICAL ENTERPRISE LLC
Entity Type:Organization
Organization Name:LJLMEDICAL ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:985-726-0984
Mailing Address - Street 1:34030 TUPELO LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-3028
Mailing Address - Country:US
Mailing Address - Phone:985-726-0984
Mailing Address - Fax:985-726-0985
Practice Address - Street 1:34030 TUPELO LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-3028
Practice Address - Country:US
Practice Address - Phone:985-726-0984
Practice Address - Fax:985-726-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies