=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780441105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JA HOLDINGS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2024
-----------------------------------------------------
Last Update Date | 03/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2266 CHANTICLEER AVE
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95062-1836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-471-8236
-----------------------------------------------------
Fax | 831-722-2982
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2266 CHANTICLEER AVE
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95062-1836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-471-8236
-----------------------------------------------------
Fax | 831-722-2982
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JOANNE SIMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 831-471-8236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------