Provider Demographics
NPI:1417455734
Name:JEVS CARE AT HOME
Entity Type:Organization
Organization Name:JEVS CARE AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP ORGANIZATIONAL DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-298-1619
Mailing Address - Street 1:9350 ASHTON RD RM 102
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-7401
Mailing Address - Country:US
Mailing Address - Phone:267-298-1619
Mailing Address - Fax:
Practice Address - Street 1:6315 FORBES AVE STE B025
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1731
Practice Address - Country:US
Practice Address - Phone:412-742-4033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEVS CARE AT HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-01
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA29713601253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102748837-0004Medicaid