NPIMap

Organization Active NPI

Jha Geriatric Services, Inc

  • Clinic/Center
  • Reseda, CA
National Provider Identifier
1831264092
Registry record updated Jul 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
960000928 Issued in CA
Legal business name
JHA GERIATRIC SERVICES, INC
Practice address
18855 Victory Blvd
Reseda, CA 91335
Phone
(818) 774-3354
Fax
(818) 757-4401
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nancy Autolino
Title
Director of Ar
Phone
(818) 757-4447

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 960000928 CA Primary

Addresses

Primary practice location

18855 Victory Blvd
Reseda, CA 91335

Mailing address

7150 Tampa Ave
Attn. Fiscal Dept.
Reseda, CA 91335-3700
Phone (818) 774-3000

Other identifiers 1

IdentifierTypeStateIssuer
CMM70641FMedicaidCA

Other names 1

  • Eisenberg Village Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040224001368 CA Part B Supplier - Clinic/Group Practice 2062321151 Receives reassigned benefits from 25 practitioners
2 other NPIs on this enrollment
Practice locations: Reseda, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2018997Jha Geriatric Services, Inc., Clinic18855 Victory Blvd, Reseda, CA 91335Certificate of waiverJan 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Jha Geriatric Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Joyce Eisenberg Keefer Medical CenterReseda, CA, CCN 555846 Skilled nursing facility Adp of the SNF Sep 1, 2019
Eisenberg VillageReseda, CA, CCN 055013 Skilled nursing facility Adp of the SNF Sep 1, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530489600000",
    "number": "1831264092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7150 TAMPA AVE",
            "address_2": "ATTN. FISCAL DEPT.",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913353700",
            "telephone_number": "818-774-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18855 VICTORY BLVD",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "91335",
            "telephone_number": "818-774-3354",
            "fax_number": "818-757-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JHA GERIATRIC SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2018-07-02",
        "status": "A",
        "authorized_official_last_name": "AUTOLINO",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "DIRECTOR OF AR",
        "authorized_official_telephone_number": "818-757-4447"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "960000928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70641F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eisenberg Village Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Eisenberg Village Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Reseda, CA

Sources for this page

Verify at the official NPI Registry.