MEDICARE: ALIZAY DANAY JACKSON

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	:	1720759889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIZAY DANAY JACKSON

Provider Business Mailing Address
First Line	:	675 HANCOCK AVE APT A5
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-1051
Country	:	US
Telephone Number	:	330-606-8568
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 HANCOCK AVE APT A5
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-1051
Country	:	US
Telephone Number	:	330-606-8568
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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Directions to “ ALIZAY DANAY JACKSON ” Practice Location

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