MEDICARE: JACKSON'S HOMECARE SERVICES

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1558946145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON'S HOMECARE SERVICES

Provider Business Mailing Address
First Line	:	4171 LOMAC ST STE A6
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2945
Country	:	US
Telephone Number	:	334-561-5719
Fax Number	:

Provider Business Practice Location Address
First Line	:	4171 LOMAC ST STE A6
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2945
Country	:	US
Telephone Number	:	334-561-5719
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LONDON JACKSON
Credential	:
Telephone Number	:	334-538-5511

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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