Provider Demographics
NPI:1457736779
Name:JA COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:JA COMMUNITY SERVICES, LLC
Other - Org Name:JACS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:301-523-5030
Mailing Address - Street 1:8109 HOLLYGATE DR
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2043
Mailing Address - Country:US
Mailing Address - Phone:301-523-5030
Mailing Address - Fax:
Practice Address - Street 1:6480 NEW HAMPSHIRE AVE
Practice Address - Street 2:#101
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4716
Practice Address - Country:US
Practice Address - Phone:301-523-5030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037172800Medicaid