Provider Demographics
NPI:1194368415
Name:JONES JACKSON, GINGER
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:JONES JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-7116
Mailing Address - Country:US
Mailing Address - Phone:973-943-8417
Mailing Address - Fax:
Practice Address - Street 1:162 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3040
Practice Address - Country:US
Practice Address - Phone:973-943-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness