# CCJ ADULT CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St' Mark Road Care Home, CCJ Adult Care LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063189678
- **Authorized official:** MS. BERNICE R HOSCH (ADMINISTRATOR/OPERATOR)
- **Authorized official phone:** (980) 295-3020

## Contact information

- **Practice address:** 1230 SAINT MARKS CHURCH RD, CROUSE, NC 28033-9600
- **Practice address phone:** (704) 769-4101
- **Mailing address:** PO BOX 74, BESSEMER CITY, NC 28016-0074
- **Mailing address phone:** (980) 295-3020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/23/2021
- **Last updated:** 08/23/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | FCL-036-034 | FAMILY CARE HOME | NC |