MEDICARE: AJ RESIDENCE COMMUNITY SUPPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1043195761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AJ RESIDENCE COMMUNITY SUPPORT LLC

Provider Business Mailing Address
First Line	:	14740 BELL TOWER RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3624
Country	:	US
Telephone Number	:	240-313-6344
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 STAPLES MILL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-4923
Country	:	US
Telephone Number	:	240-313-6344
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLINE NYAH
Credential	:
Telephone Number	:	240-313-6344

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	08/11/2025

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