Healthcare Provider Details

I. General information

NPI: 1174223721
Provider Name (Legal Business Name): AJA PRINCIPLED LIVING GOOD COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 WOODDUCK CT
SOLON OH
44139-5080
US

IV. Provider business mailing address

7050 WOODDUCK CT
SOLON OH
44139-5080
US

V. Phone/Fax

Practice location:
  • Phone: 740-669-6466
  • Fax:
Mailing address:
  • Phone: 740-669-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DANA PERKINS
Title or Position: DIRECTOR
Credential: ED.S
Phone: 740-669-6466