Healthcare Provider Details

I. General information

NPI: 1164673489
Provider Name (Legal Business Name): AJH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 STATE ST 2ND FLOOR
HACKENSACK NJ
07601-5529
US

IV. Provider business mailing address

316 STATE ST 2ND FLOOR
HACKENSACK NJ
07601-5529
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-3399
  • Fax: 201-489-3699
Mailing address:
  • Phone: 201-489-3399
  • Fax: 201-489-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0104700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMARILIS A ESPINAL
Title or Position: PART OWNER
Credential:
Phone: 201-489-3399