Provider Demographics
NPI:1497319131
Name:AYA HOUSE, INC.
Entity Type:Organization
Organization Name:AYA HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PERCIVAL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CPSS
Authorized Official - Phone:704-939-9629
Mailing Address - Street 1:1572 DALE EARNHARDT BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3208
Mailing Address - Country:US
Mailing Address - Phone:704-939-9629
Mailing Address - Fax:
Practice Address - Street 1:1572 DALE EARNHARDT BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3208
Practice Address - Country:US
Practice Address - Phone:704-939-9629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health