Provider Demographics
NPI:1467062539
Name:JACKSONS YOUTH AND FAMILY SERVICE
Entity Type:Organization
Organization Name:JACKSONS YOUTH AND FAMILY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-920-2791
Mailing Address - Street 1:3101 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2645
Mailing Address - Country:US
Mailing Address - Phone:602-920-2791
Mailing Address - Fax:928-569-7054
Practice Address - Street 1:3101 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2645
Practice Address - Country:US
Practice Address - Phone:602-920-2791
Practice Address - Fax:928-569-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health