Organization
AJINDA II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKY ALLEN PAYLOR (ADMINISTRATOR)
(919) 496-2906
Entity
Organization
Contact information
Practice address
1359 SUTTON RD, LOUISBURG, NC 27549-6625
(919) 496-2906
Mailing address
1359 SUTTON RD, LOUISBURG, NC 27549-6625
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
225800000X
Recreation Therapist
—
—
225C00000X
Rehabilitation Counselor
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
FCL 035 018
NC
343900000X
Non-emergency Medical Transport (VAN)
—
NC
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Enumeration date
03/04/2008
Last updated
11/19/2009
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