Provider Demographics
NPI:1154807824
Name:MJ INVESTMENT ENTERPRISES, LLC
Entity type:Organization
Organization Name:MJ INVESTMENT ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLICOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-299-5003
Mailing Address - Street 1:2 PINE LAKES PKWY N STE 7
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3644
Mailing Address - Country:US
Mailing Address - Phone:407-808-8817
Mailing Address - Fax:
Practice Address - Street 1:2 PINE LAKES PKWY N STE 7
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3644
Practice Address - Country:US
Practice Address - Phone:407-808-8817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies