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General NPI Number Information
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NPI Number | 1740641109
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Entity Type | Organization
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Legal Business Name | AJEWELL HEALTHCARE AGENCY, LLC
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 5006 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-3204
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Country | US
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Telephone | 757-240-4440
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Fax | 757-706-3568
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Provider Business Mailing Address
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Address Line | 5006 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-3204
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Country | US
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Telephone | 757-240-4440
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Fax | 757-706-3568
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Authorized Official
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Title or Position | DIRECTOR
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Name | LYNETTE QUARTLBAUM
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Credential | RN
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Telephone | 757-240-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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