MEDICARE: JACKSON AND ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1093414245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON AND ASSOCIATES INC

Provider Business Mailing Address
First Line	:	2431 76TH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1807
Country	:	US
Telephone Number	:	267-693-6861
Fax Number	:

Provider Business Practice Location Address
First Line	:	2431 76TH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1807
Country	:	US
Telephone Number	:	267-693-6861
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	PHILLIS JACKSON
Credential	:
Telephone Number	:	267-693-6861

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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