Provider Demographics
NPI:1417280249
Name:JACKSON PARK CHRISTIAN HOME, INC.
Entity Type:Organization
Organization Name:JACKSON PARK CHRISTIAN HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-228-0356
Mailing Address - Street 1:4107 GALLATIN PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-2109
Mailing Address - Country:US
Mailing Address - Phone:615-228-0356
Mailing Address - Fax:615-228-3021
Practice Address - Street 1:4107 GALLATIN PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-2109
Practice Address - Country:US
Practice Address - Phone:615-228-0356
Practice Address - Fax:615-228-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000055313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility