MEDICARE: JHA GERIATRIC SERVICES

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	261Q00000X	Clinic/Center	960000819	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811990377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JHA GERIATRIC SERVICES

Provider Business Mailing Address
First Line	:	7150 TAMPA AVE
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3700
Country	:	US
Telephone Number	:	818-774-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7150 TAMPA AVE
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335
Country	:	US
Telephone Number	:	818-774-3000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MARY M FORREST
Credential	:
Telephone Number	:	818-774-3208

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/02/2018

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