Provider Demographics
NPI:1891293874
Name:JACKSON, MARCEDA CASILDA (HOME HEALTHCARE PROV)
Entity Type:Individual
Prefix:MISS
First Name:MARCEDA
Middle Name:CASILDA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:HOME HEALTHCARE PROV
Other - Prefix:MRS
Other - First Name:MARCEDA
Other - Middle Name:CASILDA
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:832 WEST GREENS ROAD
Mailing Address - Street 2:APT 213
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067
Mailing Address - Country:US
Mailing Address - Phone:832-210-8345
Mailing Address - Fax:
Practice Address - Street 1:832 WEST GREENS ROAD
Practice Address - Street 2:APT 213
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067
Practice Address - Country:US
Practice Address - Phone:832-210-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health