Healthcare Provider Details

I. General information

NPI: 1003074956
Provider Name (Legal Business Name): AJA ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8726 W MILL RD
MILWAUKEE WI
53225-1838
US

IV. Provider business mailing address

8726 W MILL RD
MILWAUKEE WI
53225-1838
US

V. Phone/Fax

Practice location:
  • Phone: 414-353-9250
  • Fax: 414-353-2095
Mailing address:
  • Phone: 414-353-9250
  • Fax: 414-353-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number2083P0901X
License Number StateWI

VIII. Authorized Official

Name: MS. BEVELYN JOYCE JOHNSON
Title or Position: PRESIDENT/OWNER
Credential: LCSW
Phone: 414-353-9250