Provider Demographics
NPI:1568803252
Name:B II AJ OUR HOUSE, LLC
Entity Type:Organization
Organization Name:B II AJ OUR HOUSE, LLC
Other - Org Name:AJ'S AMETHYST HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARLEAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRUAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-294-5881
Mailing Address - Street 1:43500 RIDGE PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3624
Mailing Address - Country:US
Mailing Address - Phone:951-294-5881
Mailing Address - Fax:951-693-2007
Practice Address - Street 1:1119 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-3856
Practice Address - Country:US
Practice Address - Phone:951-294-5881
Practice Address - Fax:951-693-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility