Provider Demographics
NPI:1639276025
Name:JACKSON NORTH
Entity Type:Organization
Organization Name:JACKSON NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UTILIZATION REVIEW SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-466-2800
Mailing Address - Street 1:20201 NW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1755
Mailing Address - Country:US
Mailing Address - Phone:305-249-6815
Mailing Address - Fax:
Practice Address - Street 1:20201 NW 37TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33056-1755
Practice Address - Country:US
Practice Address - Phone:786-466-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7629273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit