Candelaria M Jackson

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1058 E Worthy St Ste B-2
Gonzales, LA 70737-4359

Phone

(225) 450-3216

NPI assigned

Jun 13, 2023

Sex

Female

Sole proprietor

No

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Enhance Health Care Services Behavioral Health, LLC

  • Community/Behavioral Health Agency
  • Gonzales, LA
  • NPI 1366981557
  NPD

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

{
    "created_epoch": "1686614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1609550342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10132 TRIBBET ST",
            "city": "SAINT JAMES",
            "state": "LA",
            "postal_code": "700867637",
            "telephone_number": "225-206-2926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1058 E WORTHY ST STE B-2",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707374359",
            "telephone_number": "225-450-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CANDELARIA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-13",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Island Enterprises, Inc.
• Island Enterprises, Inc.
• Island Enterprises, Inc.
• Island Enterprises, Inc.
• Janis Kaye Ivey, LCSW
• Chandra Alisa Jackson, MHP
• Lauren Ashley Jackson
• Taye-Rafael Jackson
• Vanessa Jacobs, BA
• Shanda James, LPC-S, NCC, BC-TMH

• All providers in Gonzales, LA
• Case Manager/Care Coordinator in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.