Healthcare Provider Details

I. General information

NPI: 1407249113
Provider Name (Legal Business Name): JACKSON HEALTH NETWORK L3C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

205 N EAST AVE
JACKSON MI
49201-1753
US

V. Phone/Fax

Practice location:
  • Phone: 517-841-7477
  • Fax: 517-768-7740
Mailing address:
  • Phone: 517-841-7477
  • Fax: 517-768-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: AMY SCHULTZ
Title or Position: MD / DIR-PREVENTION COMM HLTH
Credential:
Phone: 517-841-7433