Jackie Fields Foundation

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

JACKIE FIELDS FOUNDATION

Practice address

2303 Pickens
Muskogee, OK 74402

Phone

(918) 913-6017

NPI assigned

Nov 30, 2010

Last updated

Nov 30, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jackie Devorah Stanford, ADM RESIDENTAL CARE

Title

Ceo

Phone

(918) 913-6017

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291075200000",
    "number": "1578865317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POB 1810 2303 PICKENS",
            "city": "MUSKIGEE",
            "state": "OK",
            "postal_code": "74402",
            "telephone_number": "918-913-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 PICKENS",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "74402",
            "telephone_number": "918-913-6017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKIE FIELDS FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-30",
        "last_updated": "2010-11-30",
        "status": "A",
        "authorized_official_last_name": "STANFORD",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "DEVORAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-913-6017",
        "authorized_official_credential": "ADM RESIDENTAL CARE"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J S Rutherford MD PC
• J'Dene Michelle Rogers (Integrity Pathways)
• Jack C. Montgomery VA Medical Center
• Jack C. Montgomery VA Medical Center
• Jack E Weaver, MD PC
• Margo Jackson-Lockyer, MD
• Lisa Jackson, PRSS
• Nancy Lee Jackson, R.N.
• Paige Nicole Jackson
• Sara E. Jackson, COTA/L

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; 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.