NPIMap

Organization Active NPI

Jackson Family Homes, Inc.

  • Community/Behavioral Health Agency
  • Charlotte, NC
National Provider Identifier
1629166327
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
8301472 Issued in NC
Legal business name
JACKSON FAMILY HOMES, INC.
Practice address
11808 Provincetowne Dr
Charlotte, NC 28277-9165
Phone
(704) 846-2295
Fax
(704) 332-3510
NPI assigned
Oct 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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
President/Ceo
Phone
(704) 846-2295

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 8301472 NC Primary

Addresses

Primary practice location

11808 Provincetowne Dr
Charlotte, NC 28277-9165

Mailing address

11808 Provincetowne Dr
Charlotte, NC 28277-9165
Phone (704) 846-2295

Other identifiers 3

IdentifierTypeStateIssuer
6603382MedicaidNC
6603584MedicaidNC
8301472MedicaidNC

Other names 1

  • Jackson Support Services, Inc Other name

National Provider Directory

National Provider Directory
Tax ID family
Jackson Family Homes Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629166327",
    "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": "704-846-2295",
            "fax_number": "704-332-3510"
        },
        {
            "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": "704-846-2295",
            "fax_number": "704-332-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON FAMILY HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ROSEMARY",
        "authorized_official_middle_name": "HELEN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "704-846-2295",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "8301472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603382",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603584",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301472",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Support Services, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.