Healthcare Provider Details

I. General information

NPI: 1932033578
Provider Name (Legal Business Name): PIERRE JACK HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 RIVER ST
MATTAPAN MA
02126-2913
US

IV. Provider business mailing address

89 RIVER ST
MATTAPAN MA
02126-2913
US

V. Phone/Fax

Practice location:
  • Phone: 678-954-1647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JACKSON PIERRE
Title or Position: CEO
Credential:
Phone: 678-954-1647