Provider Demographics
NPI:1851158463
Name:NURSE JACKSON NON MEDICAL CARE LLC
Entity Type:Organization
Organization Name:NURSE JACKSON NON MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-845-0116
Mailing Address - Street 1:111 WALDING DR
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-3434
Mailing Address - Country:US
Mailing Address - Phone:334-845-0116
Mailing Address - Fax:
Practice Address - Street 1:110 E BROAD ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-2024
Practice Address - Country:US
Practice Address - Phone:334-845-0116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health