Provider Demographics
NPI:1902180557
Name:JEFFERSON AREA BOARD FOR AGING
Entity Type:Organization
Organization Name:JEFFERSON AREA BOARD FOR AGING
Other - Org Name:JABA
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-817-5237
Mailing Address - Street 1:674 HILLSDALE DR STE 9
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1799
Mailing Address - Country:US
Mailing Address - Phone:434-817-5222
Mailing Address - Fax:
Practice Address - Street 1:674 HILLSDALE DR STE 9
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1799
Practice Address - Country:US
Practice Address - Phone:434-817-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0154651076Medicaid