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General NPI Number Information
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NPI Number | 1013796465
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Entity Type | Individual
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Provider Name | MS. SAMANTHA LOVIE JACKSON
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 4663 BURLEIGH RD
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-1211
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Country | US
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Telephone | 818-299-7648
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Fax |
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Provider Business Mailing Address
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Address Line | 4663 BURLEIGH RD
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-1211
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Country | US
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Telephone | 216-534-8945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 602833990524
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License Number State | OH
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