Organization
AJ RESIDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLINE NYAH RN (CHIEF EXECUTIVE OFFICER)
(703) 763-3520
Entity
Organization
Contact information
Practice address
13362 PACKARD DR, WOODBRIDGE, VA 22193-3913
(703) 763-3520
Mailing address
13362 PACKARD DR, WOODBRIDGE, VA 22193-3913
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3777
VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH & DEVELOPMENTAL SERVICES
VA
Enumeration date
08/03/2021
Last updated
08/03/2021
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