Provider Demographics
NPI:1700892338
Name:JACKSON HEALTHCARE SYSTEMS
Entity Type:Organization
Organization Name:JACKSON HEALTHCARE SYSTEMS
Other - Org Name:AUXI HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSNAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-799-0270
Mailing Address - Street 1:4200 COMMERCE CT STE 102
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4557
Mailing Address - Country:US
Mailing Address - Phone:630-799-0270
Mailing Address - Fax:
Practice Address - Street 1:4200 COMMERCE CT STE 102
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4557
Practice Address - Country:US
Practice Address - Phone:630-799-0270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003054251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL8601Medicare ID - Type Unspecified