Provider Demographics
NPI:1366061301
Name:JANNIC HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:JANNIC HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONN
Authorized Official - Middle Name:MAHATMA
Authorized Official - Last Name:D'MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-249-8410
Mailing Address - Street 1:26970 HAYWARD BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-2088
Mailing Address - Country:US
Mailing Address - Phone:510-660-0488
Mailing Address - Fax:510-660-0487
Practice Address - Street 1:26970 HAYWARD BLVD APT 206
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-2088
Practice Address - Country:US
Practice Address - Phone:510-660-0488
Practice Address - Fax:510-660-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Yes253Z00000XAgenciesIn Home Supportive Care
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care