Provider Demographics
NPI:1538632567
Name:A&J SENIOR PRIVATE CARE LLC
Entity type:Organization
Organization Name:A&J SENIOR PRIVATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNA STATE LICENSE
Authorized Official - Phone:813-504-4188
Mailing Address - Street 1:17234 MADISON GREEN DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3274
Mailing Address - Country:US
Mailing Address - Phone:813-504-4188
Mailing Address - Fax:
Practice Address - Street 1:17234 MADISON GREEN DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3274
Practice Address - Country:US
Practice Address - Phone:813-504-4188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health