MEDICARE: VALERIE M JACKSON ENTERPRISES LLC

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		TX

General Provider Information

NPI Number	:	1205014008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALERIE M JACKSON ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	14811 WEST RD APT 3103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3174
Country	:	US
Telephone Number	:	281-463-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	14811 WEST RD APT 3103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3174
Country	:	US
Telephone Number	:	281-463-2054
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. VALERIE M JACKSON
Credential	:	NURSE AIDE REGISTRY
Telephone Number	:	713-775-0049

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	02/06/2008

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