Shirley Jackson

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

RN218146 Issued in OH

Practice address

2151 Rush Blvd
Youngstown, OH 44507-1535

Phone

(330) 744-1181

Fax

(330) 746-3353

NPI assigned

Dec 28, 2016

Last updated

Dec 28, 2016By the provider in NPPES

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

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": "1482883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1558806687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 RUSH BLVD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445071535",
            "telephone_number": "330-744-1181",
            "fax_number": "330-746-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 RUSH BLVD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445071535",
            "telephone_number": "330-744-1181",
            "fax_number": "330-746-3353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHIRLEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-28",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "OH",
            "license": "RN218146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Letitia C Jackson
• Morgan Jackson, CNA
• Onesty Jackson
• Patricia F Jackson, LPN
• Priscilla Lynette Jackson, AIDE
• Taylor Jackson
• Tekah Jackson
• Torrean Darnell Jackson, CDCA
• Troy Jackson, B.A.
• Coree Lynn Jacobs

• Substance Abuse Rehabilitation Facility in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Substance Abuse Rehabilitation Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.