Provider Demographics
NPI:1902403041
Name:JHA GERIATRIC SERVICES, INC
Entity Type:Organization
Organization Name:JHA GERIATRIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUTOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-757-4447
Mailing Address - Street 1:7150 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3700
Mailing Address - Country:US
Mailing Address - Phone:818-942-2284
Mailing Address - Fax:818-757-4401
Practice Address - Street 1:12490 FIELDING CIRCLE
Practice Address - Street 2:SUITE 174
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-3024
Practice Address - Country:US
Practice Address - Phone:424-216-7239
Practice Address - Fax:818-655-0421
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JHA GERIATRIC SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy