Provider Demographics
NPI:1205294600
Name:LJP HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:LJP HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SONGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:614-917-3157
Mailing Address - Street 1:1801 N TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2704
Mailing Address - Country:US
Mailing Address - Phone:980-333-1135
Mailing Address - Fax:
Practice Address - Street 1:1801 NORTH TRYON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-6217
Practice Address - Country:US
Practice Address - Phone:980-333-1135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112329Medicaid