Provider Demographics
NPI:1083163398
Name:JACKSON CARE LLC
Entity Type:Organization
Organization Name:JACKSON CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ACELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-552-4493
Mailing Address - Street 1:342 N WATER ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5514
Mailing Address - Country:US
Mailing Address - Phone:214-552-4493
Mailing Address - Fax:
Practice Address - Street 1:342 N WATER ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5514
Practice Address - Country:US
Practice Address - Phone:214-552-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health