Provider Demographics
NPI:1083060479
Name:JACK AND JILL TRANSITIONAL LIVING INC.
Entity Type:Organization
Organization Name:JACK AND JILL TRANSITIONAL LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-782-5553
Mailing Address - Street 1:12891 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3315
Mailing Address - Country:US
Mailing Address - Phone:313-782-5553
Mailing Address - Fax:
Practice Address - Street 1:12891 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3315
Practice Address - Country:US
Practice Address - Phone:313-782-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services