Provider Demographics
NPI:1144970542
Name:CJK COMMUNITY HOMES
Entity type:Organization
Organization Name:CJK COMMUNITY HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOEMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAGATIN-PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-507-3576
Mailing Address - Street 1:2367 TACOMA AVE S # 215
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1409
Mailing Address - Country:US
Mailing Address - Phone:253-507-3576
Mailing Address - Fax:
Practice Address - Street 1:2367 TACOMA AVE S # 215
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1409
Practice Address - Country:US
Practice Address - Phone:253-507-3576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health