Provider Demographics
NPI:1376647552
Name:AJ & T INDEPENDENT GROUP HOMES
Entity Type:Organization
Organization Name:AJ & T INDEPENDENT GROUP HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:OROBIA
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-226-9037
Mailing Address - Street 1:3420 PLUM CRESCENT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2815
Mailing Address - Country:US
Mailing Address - Phone:757-404-9761
Mailing Address - Fax:757-301-2508
Practice Address - Street 1:5132 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6022
Practice Address - Country:US
Practice Address - Phone:757-226-9037
Practice Address - Fax:757-301-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA74501001320900000X
VA314000000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered385H00000XRespite Care FacilityRespite Care