Healthcare Provider Details

I. General information

NPI: 1831264092
Provider Name (Legal Business Name): JHA GERIATRIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18855 VICTORY BLVD
RESEDA CA
91335
US

IV. Provider business mailing address

7150 TAMPA AVE ATTN. FISCAL DEPT.
RESEDA CA
91335-3700
US

V. Phone/Fax

Practice location:
  • Phone: 818-774-3354
  • Fax: 818-757-4401
Mailing address:
  • Phone: 818-774-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number960000928
License Number StateCA

VIII. Authorized Official

Name: NANCY AUTOLINO
Title or Position: DIRECTOR OF AR
Credential:
Phone: 818-757-4447