Healthcare Provider Details

I. General information

NPI: 1386118016
Provider Name (Legal Business Name): LAJ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 5TH STREET SUITE 8
FAIRPLAY CO
80440
US

IV. Provider business mailing address

5051 PAY IT FORWARD DR APT 201
CASPER WY
82609-4514
US

V. Phone/Fax

Practice location:
  • Phone: 308-289-9662
  • Fax:
Mailing address:
  • Phone: 308-289-9662
  • Fax: 888-638-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAYME M FROM
Title or Position: CO-OWNER
Credential:
Phone: 308-289-9662