Provider Demographics
NPI:1508504309
Name:JACKSON RECOVERY CENTERS
Entity Type:Organization
Organization Name:JACKSON RECOVERY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-391-1000
Mailing Address - Street 1:800 5TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1324
Mailing Address - Country:US
Mailing Address - Phone:712-234-2300
Mailing Address - Fax:
Practice Address - Street 1:2322 E KIMBERLY RD STE 200N
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-7216
Practice Address - Country:US
Practice Address - Phone:563-355-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder