Healthcare Provider Details

I. General information

NPI: 1811167000
Provider Name (Legal Business Name): AJINDA II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 SUTTON RD
LOUISBURG NC
27549-6625
US

IV. Provider business mailing address

1359 SUTTON RD
LOUISBURG NC
27549-6625
US

V. Phone/Fax

Practice location:
  • Phone: 919-496-2906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberFCL 035 018
License Number StateNC

VIII. Authorized Official

Name: RICKY ALLEN PAYLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-496-2906