Jackies Retirement LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

AL12053 Issued in FL

Legal business name

JACKIES RETIREMENT LLC

Doing business as

Jackies retirement alf

Practice address

1675 Canon Ave NW
Palm Bay, FL 32907-8528

Phone

(321) 420-3916

NPI assigned

Dec 26, 2011

Last updated

Dec 26, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Jacqueline B Wright

Title

Administrator/Owner

Phone

(321) 420-3916

Specialties & licenses 1

Addresses

Other names 1

• Jackies retirement alf Doing business as

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

{
    "created_epoch": "1324857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324857600000",
    "number": "1073882783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 CANON AVE NW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329078528",
            "telephone_number": "321-420-3916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 CANON AVE NW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329078528",
            "telephone_number": "321-420-3916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKIES RETIREMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-26",
        "last_updated": "2011-12-26",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "321-420-3916",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "FL",
            "license": "AL12053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackies retirement alf",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Keith Jackman
• Kelley Anne Jackson, M.A. CCC-SLP
• Monica D Jackson, PA
• Tierra Jackson, LPCA, LMFTA, RMFTI
• Lakenya Jacobs

• Exclusive Provider Organization in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2011; 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.