Provider Demographics
NPI:1083025076
Name:FOLSE, JADA
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:FOLSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 HARRISON ST
Mailing Address - Street 2:201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612
Mailing Address - Country:US
Mailing Address - Phone:510-981-4126
Mailing Address - Fax:
Practice Address - Street 1:1415 HARRISON ST
Practice Address - Street 2:201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3922
Practice Address - Country:US
Practice Address - Phone:510-981-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70474GMedicaid