NPIMap

Organization Active NPI

Jackson County Youth Center

  • Early Intervention Provider Agency
  • Jackson, MI
National Provider Identifier
1306232632
Registry record updated Apr 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
CO380201204 Issued in MI
Legal business name
JACKSON COUNTY YOUTH CENTER
Practice address
930 Fleming Ave
Jackson, MI 49202-2534
Phone
(517) 788-4460
Fax
(517) 788-4661
NPI assigned
Apr 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2015

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

Authorized official

Name
Mr. Geremy C Burns, MA
Title
Director
Phone
(517) 768-2778

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X CO380201204 MI Primary

Addresses

Primary practice location

930 Fleming Ave
Jackson, MI 49202-2534

Mailing address

930 Fleming Ave
Jackson, MI 49202-2534
Phone (517) 788-4460

National Provider Directory

National Provider Directory
Tax ID family
Jackson County2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

930 Fleming Ave
Jackson, MI 49202
Phone (517) 788-4460

NPI Registry JSON

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

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428969600000",
    "number": "1306232632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 FLEMING AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022534",
            "telephone_number": "517-788-4460",
            "fax_number": "517-788-4661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 FLEMING AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022534",
            "telephone_number": "517-788-4460",
            "fax_number": "517-788-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY YOUTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-14",
        "last_updated": "2015-04-14",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "GEREMY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "517-768-2778",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "MI",
            "license": "CO380201204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; 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.