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General NPI Number Information
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NPI Number | 1386118016
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Entity Type | Organization
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Legal Business Name | LAJ, INC.
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 295 5TH STREET SUITE 8
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City | FAIRPLAY
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State | CO
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Zip | 80440
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Country | US
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Telephone | 308-289-9662
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Fax |
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Provider Business Mailing Address
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Address Line | 5051 PAY IT FORWARD DR APT 201
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City | CASPER
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State | WY
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Zip | 82609-4514
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Country | US
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Telephone | 308-289-9662
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Fax | 888-638-3941
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Authorized Official
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Title or Position | CO-OWNER
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Name | JAYME M FROM
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Credential |
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Telephone | 308-289-9662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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