Healthcare Provider Details

I. General information

NPI: 1457736779
Provider Name (Legal Business Name): JA COMMUNITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 NEW HAMPSHIRE AVE #101
TAKOMA PARK MD
20912-4716
US

IV. Provider business mailing address

8109 HOLLYGATE DR
GLENN DALE MD
20769-2043
US

V. Phone/Fax

Practice location:
  • Phone: 301-523-5030
  • Fax:
Mailing address:
  • Phone: 301-523-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH A POWELL JR.
Title or Position: PRESIDENT
Credential: M.S.
Phone: 301-523-5030