Healthcare Provider Details

I. General information

NPI: 1316684830
Provider Name (Legal Business Name): GEMS OF JACKSON CHILD CARE & EDUCATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 1ST ST STE 2
JACKSON MI
49203-3034
US

IV. Provider business mailing address

1203 1ST ST STE 2
JACKSON MI
49203-3034
US

V. Phone/Fax

Practice location:
  • Phone: 248-421-4594
  • Fax:
Mailing address:
  • Phone: 248-421-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. VITTORIA JIMERSON
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 248-421-4594