Provider Demographics
NPI:1861553893
Name:J. CARLTON ENTERPRISES, LLC.
Entity type:Organization
Organization Name:J. CARLTON ENTERPRISES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CENTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-344-9933
Mailing Address - Street 1:3715 HAWKINS ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4555
Mailing Address - Country:US
Mailing Address - Phone:505-344-9933
Mailing Address - Fax:505-344-9955
Practice Address - Street 1:3715 HAWKINS ST NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4555
Practice Address - Country:US
Practice Address - Phone:505-344-9933
Practice Address - Fax:505-344-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM02-366280-00-8332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR6068Medicaid
NM1201410001Medicare ID - Type Unspecified
NMR6068Medicaid
NM1201410002Medicare ID - Type Unspecified