NPIMap

Organization Active NPI

Jackson Recovery Centers, Inc.

  • Substance Abuse Rehabilitation Facility
  • Sioux City, IA
National Provider Identifier
1649603283
Registry record updated Aug 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1237 Issued in IA
Legal business name
JACKSON RECOVERY CENTERS, INC.
Practice address
2101 Court St
Sioux City, IA 51104-3243
Phone
(712) 293-4912
Fax
(712) 293-4804
NPI assigned
Aug 19, 2013
Last updated
Aug 19, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
JACKSON RECOVERY CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2013

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

Authorized official

Name
Mr. Kermit Dahlen
Title
Ceo/President
Phone
(712) 234-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 1237 IA Primary

Addresses

Primary practice location

2101 Court St
Sioux City, IA 51104-3243

Mailing address

800 5TH St
Sioux City, IA 51101-1317
Phone (712) 234-2300

Other names 1

  • Adolescent Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Jackson Recovery Center6 organizations share this tax ID, including this one
Part of
Jackson Recovery Center

Other organizations with this tax ID 5

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

Locations

800 5th St
Sioux City, IA 51101
Phone (712) 234-2300

NPI Registry JSON

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

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376870400000",
    "number": "1649603283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 5TH ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011317",
            "telephone_number": "712-234-2300",
            "fax_number": "712-234-2398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 COURT ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511043243",
            "telephone_number": "712-293-4912",
            "fax_number": "712-293-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON RECOVERY CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON RECOVERY CENTERS, INC.",
        "enumeration_date": "2013-08-19",
        "last_updated": "2013-08-19",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "KERMIT",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "712-234-2300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IA",
            "license": "1237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adolescent Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; 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.