Healthcare Provider Details

I. General information

NPI: 1285458927
Provider Name (Legal Business Name): A&J HEALTH ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12153 72ND ST NE
OTSEGO MN
55330-5064
US

IV. Provider business mailing address

12153 72ND ST NE
OTSEGO MN
55330-5064
US

V. Phone/Fax

Practice location:
  • Phone: 773-458-0942
  • Fax: 612-454-2583
Mailing address:
  • Phone: 773-458-0942
  • Fax: 612-454-2583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ALBRITTON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 773-458-0942