MEDICARE: JSA INTERESTS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1063096923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSA INTERESTS, INC

Provider Business Mailing Address
First Line	:	6748 S OLIVET DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2713
Country	:	US
Telephone Number	:	801-381-2731
Fax Number	:

Provider Business Practice Location Address
First Line	:	6748 S OLIVET DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2713
Country	:	US
Telephone Number	:	801-381-2731
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. JOEL STEPHEN ASHBY
Credential	:	MBA
Telephone Number	:	801-381-2731

Provider Enumeration Date	:	05/07/2021
Last Update Date	:	05/07/2021

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