MEDICARE: AYA HOUSE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1497319131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AYA HOUSE, INC.

Provider Business Mailing Address
First Line	:	1572 DALE EARNHARDT BLVD
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28083-3208
Country	:	US
Telephone Number	:	704-939-9629
Fax Number	:

Provider Business Practice Location Address
First Line	:	1572 DALE EARNHARDT BLVD
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28083-3208
Country	:	US
Telephone Number	:	704-939-9629
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. DENNIS PERCIVAL BROWN
Credential	:	CPSS
Telephone Number	:	704-939-9629

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	12/18/2024

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Directions to “AYA HOUSE, INC. ” Practice Location

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