Provider Demographics
NPI:1316537905
Name:AJINNDA 13 GROUP LIVING FACILITY
Entity Type:Organization
Organization Name:AJINNDA 13 GROUP LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:919-906-4426
Mailing Address - Street 1:408 W MOREHEAD ST
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4937
Mailing Address - Country:US
Mailing Address - Phone:919-906-4426
Mailing Address - Fax:
Practice Address - Street 1:408 W MOREHEAD ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4937
Practice Address - Country:US
Practice Address - Phone:919-906-4426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health