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General NPI Number Information
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NPI Number | 1225449358
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Entity Type | Organization
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Legal Business Name | JAYS HOLISTIC SERVICES
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 1642 N MCVICKER AVE
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City | CHICAGO
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State | IL
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Zip | 60639-3914
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Country | US
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Telephone | 773-860-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 1642 N MCVICKER
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City | CHICAGO
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State | IL
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Zip | 60639
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN BRIDGES
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Credential |
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Telephone | 773-860-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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