Provider Demographics
NPI:1679714141
Name:JACKSON'S PROFESSIONAL HOMECARE SERVICES
Entity Type:Organization
Organization Name:JACKSON'S PROFESSIONAL HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-281-0555
Mailing Address - Street 1:2615 E SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2509
Mailing Address - Country:US
Mailing Address - Phone:334-281-0555
Mailing Address - Fax:334-281-0222
Practice Address - Street 1:2615 E SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2509
Practice Address - Country:US
Practice Address - Phone:334-281-0555
Practice Address - Fax:334-281-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL06922385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child