CCJ Adult Care LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

CCJ ADULT CARE LLC

Doing business as

CCJ Adult Care LLC
St' Mark Road Care Home

Practice address

1230 Saint Marks Church Rd
Crouse, NC 28033-9600

Phone

(704) 769-4101

NPI assigned

Aug 23, 2021

Last updated

Aug 23, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Bernice R Hosch

Title

Administrator/Operator

Phone

(980) 295-3020

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• CCJ Adult Care LLC Doing business as
• St' Mark Road Care Home Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629676800000",
    "number": "1063189678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74",
            "city": "BESSEMER CITY",
            "state": "NC",
            "postal_code": "280160074",
            "telephone_number": "980-295-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 SAINT MARKS CHURCH RD",
            "city": "CROUSE",
            "state": "NC",
            "postal_code": "280339600",
            "telephone_number": "704-769-4101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 W Main Ave Apt 302",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280524172",
            "country_code": "US",
            "telephone_number": "980-295-3020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CCJ ADULT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "HOSCH",
        "authorized_official_first_name": "BERNICE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR/OPERATOR",
        "authorized_official_telephone_number": "980-295-3020",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY CARE HOME",
            "identifier": "FCL-036-034",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCJ Adult Care LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St' Mark Road Care Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brian Daniel Finney II, RN
• Harris Enterprise of NC, Inc. (Walden Pond Care)
• Harris Enterprises of NC, Inc (Doing Business As: St Mark's Road Care Home)
• Ashley Hughes
• Allison Shortridge

• Adult Care Home Facility in Crouse, NC
• Providers in Crouse, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.