Provider Demographics
NPI:1427712355
Name:CJW LIFE CARE LLC
Entity type:Organization
Organization Name:CJW LIFE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMALITA
Authorized Official - Middle Name:GENAY
Authorized Official - Last Name:ESCOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-390-9335
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23923-0573
Mailing Address - Country:US
Mailing Address - Phone:434-390-9335
Mailing Address - Fax:
Practice Address - Street 1:312 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23923-3789
Practice Address - Country:US
Practice Address - Phone:434-390-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty