Provider Demographics
NPI:1710393798
Name:JACKSON GRAYSON & CAMPBELL
Entity Type:Organization
Organization Name:JACKSON GRAYSON & CAMPBELL
Other - Org Name:COMFORCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:EMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-359-4141
Mailing Address - Street 1:6100 NEWPORT RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-9235
Mailing Address - Country:US
Mailing Address - Phone:269-359-4141
Mailing Address - Fax:
Practice Address - Street 1:6100 NEWPORT RD
Practice Address - Street 2:SUITE 208
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-9235
Practice Address - Country:US
Practice Address - Phone:269-359-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care