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General NPI Number Information
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NPI Number | 1083521314
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Entity Type | Organization
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Legal Business Name | JACKSON LANE ADULT FAMILY HOME
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 5308 JACKSON LN
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City | PASCO
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State | WA
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Zip | 99301-9756
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Country | US
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Telephone | 206-402-8182
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Fax | 509-207-7943
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Provider Business Mailing Address
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Address Line | 5308 JACKSON LN
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City | PASCO
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State | WA
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Zip | 99301-9756
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Country | US
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Telephone | 206-402-8182
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Fax | 509-207-7943
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Authorized Official
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Title or Position | PROVIDER
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Name | MARTIN NJERI
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Credential |
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Telephone | 206-402-8182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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