Provider Demographics
NPI:1578212452
Name:MJ CARE SERVICES LLC
Entity type:Organization
Organization Name:MJ CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANOUCHKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, CPNP
Authorized Official - Phone:908-553-8787
Mailing Address - Street 1:2 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-6742
Mailing Address - Country:US
Mailing Address - Phone:908-553-8787
Mailing Address - Fax:
Practice Address - Street 1:2 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-6742
Practice Address - Country:US
Practice Address - Phone:908-553-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty