Healthcare Provider Details

I. General information

NPI: 1356021570
Provider Name (Legal Business Name): RHONDA J JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 BARCLAY SQ S
COLUMBUS OH
43209-3823
US

IV. Provider business mailing address

2955 BARCLAY SQ S
COLUMBUS OH
43209-3823
US

V. Phone/Fax

Practice location:
  • Phone: 614-935-2354
  • Fax:
Mailing address:
  • Phone: 614-935-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: