MEDICARE: JCL HOME CARE SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility
2	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1639320005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JCL HOME CARE SERVICES INC.

Provider Business Mailing Address
First Line	:	23948 CALIFA ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2955
Country	:	US
Telephone Number	:	818-992-7665
Fax Number	:	818-500-7315

Provider Business Practice Location Address
First Line	:	23948 CALIFA ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2955
Country	:	US
Telephone Number	:	818-992-7665
Fax Number	:	818-500-7315

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	LEONARD ROY LANSANGAN
Credential	:
Telephone Number	:	818-321-7338

Provider Enumeration Date	:	10/03/2008
Last Update Date	:	10/03/2008

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