Provider Demographics
NPI:1508218983
Name:JHLC MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:JHLC MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEELAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHATEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-8410
Mailing Address - Street 1:3150 HOWELL MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2108
Mailing Address - Country:US
Mailing Address - Phone:404-351-8410
Mailing Address - Fax:
Practice Address - Street 1:3150 HOWELL MILL RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2108
Practice Address - Country:US
Practice Address - Phone:404-351-8410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH HOME LIFE COMMUNITIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-08
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-130-H171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA060-130-HOtherLICENSE