Monica Jackson, ADMINISTRATOR

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

197610284 Issued in CA

Practice address

6222 W Avenue J9
Lancaster, CA 93536-1735

Phone

(661) 609-7719

NPI assigned

Oct 6, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1033834593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6222 W AVENUE J9",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935361735",
            "telephone_number": "661-609-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6222 W AVENUE J9",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935361735",
            "telephone_number": "661-609-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MONICA",
        "credential": "ADMINISTRATOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-06",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": "197610284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "2603:8001:1b00:4c1f:b573:e3d7:bf6e:af9b",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "6222 W Avenue J9",
            "city": "Lancaster",
            "state": "CA",
            "country_code": "US",
            "postal_code": "935361735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lateshia Marie Jackson
• Leroy Jackson
• Malika Shantee Jackson
• Marykatherine Elaine Jackson
• Mia Lauren Jackson
• Raquel G. Jackson, MFT INTERN
• Robert M Jackson, M.D.
• Susan Michelle Jackson
• Victoria Lynn Jackson
• Lauren Jane Jacobs, BCBA

• Community Based Hospice Care Agency in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.