Healthcare Provider Details

I. General information

NPI: 1174418198
Provider Name (Legal Business Name): JACKSON PREFERRED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10711 SW 216TH ST # 201
MIAMI FL
33170-3139
US

IV. Provider business mailing address

17516 DUVAL AVE
MIAMI FL
33157-5322
US

V. Phone/Fax

Practice location:
  • Phone: 786-227-6543
  • Fax: 305-939-0826
Mailing address:
  • Phone: 786-531-1923
  • Fax: 786-531-1923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: CASHAE T MORTON
Title or Position: HOME AND COMMUNITY BASED PROVIDER
Credential:
Phone: 786-227-6543