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General NPI Number Information
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NPI Number | 1588816623
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Entity Type | Organization
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Legal Business Name | JACKSON CORP
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 5130 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60644-4332
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Country | US
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Telephone | 773-921-8000
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Fax | 773-921-3980
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Provider Business Mailing Address
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Address Line | 7257 N LINCOLN AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1810
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Country | US
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Telephone | 847-933-2600
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Fax | 847-933-0686
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Authorized Official
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Title or Position | MEDICARE MANAGER
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Name | JOYCE RUDD
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Credential |
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Telephone | 847-745-6238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5074210001
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License Number State | IL
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