Provider Demographics
NPI:1568689818
Name:JACKSON CENTER FOR CONDUCTIVE EDUCATION INC
Entity Type:Organization
Organization Name:JACKSON CENTER FOR CONDUCTIVE EDUCATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DEPOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-834-0200
Mailing Address - Street 1:802 N SAMUEL MOORE PKWY
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1467
Mailing Address - Country:US
Mailing Address - Phone:317-834-0200
Mailing Address - Fax:317-834-0203
Practice Address - Street 1:802 N SAMUEL MOORE PKWY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1467
Practice Address - Country:US
Practice Address - Phone:317-834-0200
Practice Address - Fax:317-834-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1051276261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)