Individual provider · Type 1 NPI
Jacquenett Jackson
Adult Care Home Facility · Shubuta, MS
NPI number
1376727388
Active
Practice location
114 Second Street
Shubuta, MS 39360
Fax (601) 687-5497
Mailing address
PO Box 462
Shubuta, MS 39360-0462
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Care Home Facility Primary | 311ZA0620X | None listed |
Adult Care Home Facility: A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
About NPI 1376727388
Jacquenett Jackson's National Provider Identifier is 1376727388, issued on Dec 27, 2007. The primary taxonomy on file is Adult Care Home Facility (311ZA0620X), and the practice location is in Shubuta, MS. The record was last updated on Dec 27, 2007.