Provider Demographics
NPI:1649603283
Name:JACKSON RECOVERY CENTERS, INC.
Entity type:Organization
Organization Name:JACKSON RECOVERY CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KERMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-234-2300
Mailing Address - Street 1:800 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1317
Mailing Address - Country:US
Mailing Address - Phone:712-234-2300
Mailing Address - Fax:712-234-2398
Practice Address - Street 1:2101 COURT ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3243
Practice Address - Country:US
Practice Address - Phone:712-293-4912
Practice Address - Fax:712-293-4804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON RECOVERY CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1237324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility