Provider Demographics
NPI:1083766323
Name:JACKSON AREA COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCY
Entity Type:Organization
Organization Name:JACKSON AREA COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCY
Other - Org Name:JACOA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-423-3653
Mailing Address - Street 1:900 E CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-6502
Mailing Address - Country:US
Mailing Address - Phone:731-423-3653
Mailing Address - Fax:731-422-2820
Practice Address - Street 1:900 E CHESTER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-6502
Practice Address - Country:US
Practice Address - Phone:731-423-3653
Practice Address - Fax:731-422-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000044324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility