Jackson Odondi

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL-032-073 Issued in NC

Legal business name

JACKSON ODONDI

Practice address

3812 Booker Ave
Durham, NC 27713-1126

Phone

(919) 544-0874

Fax

(919) 544-0874

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Jackson Odondi

Title

Administrator

Phone

(919) 949-3585

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eden Spring Living Center Doing business as

Locations

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1356484877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15927",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277040927",
            "telephone_number": "919-544-0874",
            "fax_number": "919-544-5331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3812 BOOKER AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277131126",
            "telephone_number": "919-544-0874",
            "fax_number": "919-544-0874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON ODONDI",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "ODONDI",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-949-3585",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL-032-073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805238",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eden Spring Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Le'Shauna Yulanda Iyalekhue
• Susan Izatt
• J. Stuart McCracken, M.D., P.a.
• Kevin Jack, DC
• Jamillah A. Jackson Kelly, MS/EDS, NCC, LCMHCS
• Akua Jackson, PHD
• Alexandra Megan Jackson, CPNP
• Ashton Jackson, RDN
• Bethena M Jackson, CSAC, LCAS-A
• Brooke A Jackson, MD

• Adult Care Home Facility in Durham, NC
• Providers in Durham, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; 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.