Jackson Family Homes, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

6603584 Issued in NC

Legal business name

JACKSON FAMILY HOMES, INC.

Practice address

11808 Provincetowne Dr
Charlotte, NC 28277-9165

Phone

(704) 905-5577

Fax

(704) 846-2295

NPI assigned

Jul 26, 2007

Organization subpart

Yes

Parent organization

JACKSON FAMILY HOME, INC.As reported in NPPES

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

Authorized official

Name

Dr. Rosemary Helen Jackson, PH.D.

Title

Pres/Ceo

Phone

(704) 905-5577

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Jackson Family Homes Inc2 organizations share this tax ID, including this one

Part of

Jackson Family Homes Inc

Other organizations with this tax ID 1

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

• Jackson Family Homes, Inc.

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1629166327
  NPD tax ID

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185408000000",
    "number": "1568652501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11808 PROVINCETOWNE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282779165",
            "telephone_number": "704-905-5577",
            "fax_number": "704-846-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11808 PROVINCETOWNE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282779165",
            "telephone_number": "704-905-5577",
            "fax_number": "704-846-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON FAMILY HOMES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON FAMILY HOME, INC.",
        "enumeration_date": "2007-07-26",
        "last_updated": "2007-07-26",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ROSEMARY",
        "authorized_official_middle_name": "HELEN",
        "authorized_official_title_or_position": "PRES/CEO",
        "authorized_official_telephone_number": "704-905-5577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "6603584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301582",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gretchen M Jachim, PA-C
• Laurie Amy Jachym, L.C.S.W.
• Shelby Lynn Jackloski, MM, MS, CCC-SLP
• Sarah Kathleen Jacks, LPCA
• Jackson Consulting and Services LLC
• Jackson Family Homes, Inc.
• Jackson Home for Veterans
• Diane O Jackson-Szymczyk, PT
• Yameka Jackson-Williams, OWNER
• Adrienne Jackson

• Community/Behavioral Health Agency in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; 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.