Provider Demographics
NPI:1851038160
Name:JACKSON PSYCHIATRIC CARE, LLC
Entity Type:Organization
Organization Name:JACKSON PSYCHIATRIC CARE, LLC
Other - Org Name:ONWARD PSYCHIATRIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:607-280-8280
Mailing Address - Street 1:1 WALPOLE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3315
Mailing Address - Country:US
Mailing Address - Phone:617-958-6036
Mailing Address - Fax:617-360-3002
Practice Address - Street 1:1 WALPOLE ST STE 2
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3315
Practice Address - Country:US
Practice Address - Phone:617-958-6036
Practice Address - Fax:617-360-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty