Healthcare Provider Details

I. General information

NPI: 1083510671
Provider Name (Legal Business Name): JACKSON RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2026
Last Update Date: 10/19/2026
Certification Date: 10/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 LANGLEY AVE
JACKSON MS
39204-3115
US

IV. Provider business mailing address

5261 GREENWAY DRIVE EXT
JACKSON MS
39204-3212
US

V. Phone/Fax

Practice location:
  • Phone: 769-218-0008
  • Fax:
Mailing address:
  • Phone: 769-218-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. PUTALAMUS WHITE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-906-1591