Healthcare Provider Details

I. General information

NPI: 1194478230
Provider Name (Legal Business Name): JACKSON 1 HOME CARE AND TRANSPORTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 RUTGERS DR
LANCASTER TX
75134-2515
US

IV. Provider business mailing address

2605 RUTGERS DR
LANCASTER TX
75134-2515
US

V. Phone/Fax

Practice location:
  • Phone: 469-765-7362
  • Fax:
Mailing address:
  • Phone: 469-990-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTOPHER JACKSON
Title or Position: CEO
Credential:
Phone: 469-990-9831