Provider Demographics
NPI:1720450844
Name:J CHASE FOUNDATION
Entity Type:Organization
Organization Name:J CHASE FOUNDATION
Other - Org Name:HEALTH CARE INTEGRATED SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-675-8442
Mailing Address - Street 1:2220 OTAY LAKES RD
Mailing Address - Street 2:SUITE 502-121
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1004
Mailing Address - Country:US
Mailing Address - Phone:818-675-8442
Mailing Address - Fax:888-316-1604
Practice Address - Street 1:2220 OTAY LAKES RD
Practice Address - Street 2:SUITE 502-121
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1004
Practice Address - Country:US
Practice Address - Phone:818-675-8442
Practice Address - Fax:888-316-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center