Provider Demographics
NPI:1003363003
Name:JSA HOMECARE
Entity Type:Organization
Organization Name:JSA HOMECARE
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:M
Authorized Official - Last Name:NORTH-GILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-591-7117
Mailing Address - Street 1:10721 MAIN ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6914
Mailing Address - Country:US
Mailing Address - Phone:703-591-7117
Mailing Address - Fax:
Practice Address - Street 1:10721 MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6914
Practice Address - Country:US
Practice Address - Phone:703-591-7117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-15261251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health