Provider Demographics
NPI:1609129618
Name:JACKEY CARE'S HOUSING
Entity Type:Organization
Organization Name:JACKEY CARE'S HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:10,21,1962
Authorized Official - Phone:916-641-1641
Mailing Address - Street 1:P.O. BOX 348656
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834
Mailing Address - Country:US
Mailing Address - Phone:916-641-1641
Mailing Address - Fax:916-641-1641
Practice Address - Street 1:2447 BOXWOOD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815
Practice Address - Country:US
Practice Address - Phone:916-641-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health