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General NPI Number Information
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NPI Number | 1083388045
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Entity Type | Organization
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Legal Business Name | AJ RESIDENCE LLC
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 13362 PACKARD DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-3913
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Country | US
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Telephone | 703-763-3520
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Fax |
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Provider Business Mailing Address
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Address Line | 13362 PACKARD DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-3913
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. NICOLINE NYAH
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Credential | RN
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Telephone | 703-763-3520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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