MEDICARE: DASHIA JACKSON-DAY

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	310400000X	Assisted Living Facility		WI

General Provider Information

NPI Number	:	1144950478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DASHIA JACKSON-DAY

Provider Business Mailing Address
First Line	:	10134 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-5700
Country	:	US
Telephone Number	:	262-888-9530
Fax Number	:

Provider Business Practice Location Address
First Line	:	5371 N 51ST BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3304
Country	:	US
Telephone Number	:	262-888-9530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	12/10/2025

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