MEDICARE: A & J RESIDENTIAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251J00000X	Nursing Care Agency
3	343900000X	Non-emergency Medical Transport (VAN)
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376188912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A & J RESIDENTIAL SERVICES LLC

Provider Business Mailing Address
First Line	:	2022 COUNTRY LANE CT
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2005
Country	:	US
Telephone Number	:	804-721-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	2022 COUNTRY LANE CT
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2005
Country	:	US
Telephone Number	:	804-721-0707
Fax Number	:

Authorized Official
Title or Position	:	CEO/NURSE
Name	:	MRS. JENNIFER K PEREZ
Credential	:
Telephone Number	:	804-721-0707

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/08/2023

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