Healthcare Provider Details

I. General information

NPI: 1982956058
Provider Name (Legal Business Name): NJA THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E 6TH ST SUITE 204
CORONA CA
92879
US

IV. Provider business mailing address

310 N INDIAN HILL BLVD # 413
CLAREMONT CA
91711-4611
US

V. Phone/Fax

Practice location:
  • Phone: 909-833-1099
  • Fax: 888-856-3880
Mailing address:
  • Phone: 909-833-1099
  • Fax: 888-856-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberSPA 1473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NAOMI JAYE ACHONDO
Title or Position: PRESIDENT
Credential: OTD, OTR/L, SWC
Phone: 909-833-1099