Provider Demographics
NPI:1386447381
Name:JAYAH WELLNESS LLC
Entity type:Organization
Organization Name:JAYAH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-795-8781
Mailing Address - Street 1:2012 W SAINT PAUL AVE APT 409
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3620 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3516
Practice Address - Country:US
Practice Address - Phone:818-795-8781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy