Provider Demographics
NPI:1558946145
Name:JACKSON'S HOMECARE SERVICES
Entity Type:Organization
Organization Name:JACKSON'S HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONDON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-538-5511
Mailing Address - Street 1:4171 LOMAC ST STE A6
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2945
Mailing Address - Country:US
Mailing Address - Phone:334-561-5719
Mailing Address - Fax:
Practice Address - Street 1:4171 LOMAC ST STE A6
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2945
Practice Address - Country:US
Practice Address - Phone:334-561-5719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health