Provider Demographics
NPI:1841506763
Name:JACKOSKY HEALTH INC
Entity type:Organization
Organization Name:JACKOSKY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-250-2130
Mailing Address - Street 1:30400 DETROIT RD STE 404
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1855
Mailing Address - Country:US
Mailing Address - Phone:440-250-2130
Mailing Address - Fax:440-250-2140
Practice Address - Street 1:30400 DETROIT RD STE 404
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1855
Practice Address - Country:US
Practice Address - Phone:440-250-2130
Practice Address - Fax:440-250-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350753262084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty