Healthcare Provider Details

I. General information

NPI: 1497319131
Provider Name (Legal Business Name): AYA HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 DALE EARNHARDT BLVD
KANNAPOLIS NC
28083-3208
US

IV. Provider business mailing address

1572 DALE EARNHARDT BLVD
KANNAPOLIS NC
28083-3208
US

V. Phone/Fax

Practice location:
  • Phone: 704-939-9629
  • Fax:
Mailing address:
  • Phone: 704-939-9629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS PERCIVAL BROWN
Title or Position: DIRECTOR
Credential: CPSS
Phone: 704-939-9629