Healthcare Provider Details

I. General information

NPI: 1700892338
Provider Name (Legal Business Name): JACKSON HEALTHCARE SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 COMMERCE CT STE 102
LISLE IL
60532-4557
US

IV. Provider business mailing address

4200 COMMERCE CT STE 102
LISLE IL
60532-4557
US

V. Phone/Fax

Practice location:
  • Phone: 630-799-0270
  • Fax:
Mailing address:
  • Phone: 630-799-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number003054
License Number StateTX

VIII. Authorized Official

Name: MR. MICHEL A RUSNAK
Title or Position: CEO
Credential:
Phone: 630-799-0270