Healthcare Provider Details

I. General information

NPI: 1275536732
Provider Name (Legal Business Name): JHA GERIATRIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 BALBOA BLVD STE 315
ENCINO CA
91316-1500
US

IV. Provider business mailing address

7150 TAMPA AVE
RESEDA CA
91335-3700
US

V. Phone/Fax

Practice location:
  • Phone: 818-774-3040
  • Fax:
Mailing address:
  • Phone: 818-757-4447
  • Fax: 818-757-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number980001583
License Number StateCA

VIII. Authorized Official

Name: MS. MARY M FORREST
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 818-774-3208