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General NPI Number Information
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NPI Number | 1407670896
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Entity Type | Organization
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Legal Business Name | JACKSON-RICHMOND PROPERTIES LLC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 3420 DELEUIL AVE
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City | TAMPA
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State | FL
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Zip | 33610-3621
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Country | US
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Telephone | 813-352-8824
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 DELEUIL AVE
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City | TAMPA
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State | FL
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Zip | 33610-3621
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Country | US
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Telephone | 813-352-8824
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TANIKA SHAKITA JACKSON-RICHMOND
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Credential | DNP, MSN,ED,RN
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Telephone | 813-352-8824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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