Healthcare Provider Details

I. General information

NPI: 1811720196
Provider Name (Legal Business Name): AJ PROFESSIONAL BILLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 REUBEN RD
EDEN NC
27288-7830
US

IV. Provider business mailing address

191 REUBEN RD
EDEN NC
27288-7830
US

V. Phone/Fax

Practice location:
  • Phone: 336-635-8110
  • Fax:
Mailing address:
  • Phone: 336-635-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: ANGELA P JARRELL
Title or Position: MANAGER/OWNER
Credential: CO
Phone: 336-635-8110