Organization
JHA GERIATRIC SERVICES
Active
Other names
Grancell Village Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARY M FORREST (CHIEF EXECUTIVE OFFICER)
(818) 774-3208
Entity
Organization
Contact information
Practice address
7150 TAMPA AVE, RESEDA, CA 91335
(818) 774-3000
Mailing address
7150 TAMPA AVE, RESEDA, CA 91335-3700
(818) 774-3000
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
960000819
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM70542F
—
CA
Enumeration date
05/27/2005
Last updated
07/02/2018
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