Jeffrey Carl Jackson
Individual provider Active NPI Home Health Aide · Rudolph, OH
NPI 1356087472 · NPPES record last updated May 11, 2022
Key facts
- NPI
- 1356087472
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Aide 374U00000X
- Practice address
- 9515 Rudolph Rd
Rudolph, OH 43462-9704 - Phone
- (419) 889-9324
- NPI assigned
- May 11, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Yes |
Addresses
Primary practice location
9515 Rudolph Rd
Rudolph, OH 43462-9704
Mailing address
9515 Rudolph Rd
Rudolph, OH 43462-9704
Phone (419) 889-9324
Other providers in Rudolph, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.