Healthcare Provider Details

I. General information

NPI: 1386292696
Provider Name (Legal Business Name): AJAYA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 LITTLEJOHN CHURCH RD
LENOIR NC
28645-8563
US

IV. Provider business mailing address

4010 LITTLEJOHN CHURCH RD
LENOIR NC
28645-8563
US

V. Phone/Fax

Practice location:
  • Phone: 828-292-6822
  • Fax:
Mailing address:
  • Phone: 828-292-6822
  • 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 Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRIS CAIN
Title or Position: FOUNDER/CEO
Credential: MS, QP
Phone: 828-292-6822