MEDICARE: JACKSON RECOVERY CENTERS, 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	251V00000X	Voluntary or Charitable Agency		IA
2	324500000X	Substance Abuse Rehabilitation Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68223	OTHER	IA	WELLMARK PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811994973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON RECOVERY CENTERS, INC.

Provider Business Mailing Address
First Line	:	800 5TH STREET
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51101
Country	:	US
Telephone Number	:	712-234-2300
Fax Number	:	712-234-2398

Provider Business Practice Location Address
First Line	:	800 5TH ST
Second Line	:	SUITE 200
City	:	SIOUX CITY
State	:	IA
Zip	:	51101-1317
Country	:	US
Telephone Number	:	712-234-2300
Fax Number	:	712-234-2398

Authorized Official
Title or Position	:	VICE PRESIDENT CHIEF FINANCIAL OFFI
Name	:	JULIE ENOCKSON
Credential	:
Telephone Number	:	712-234-2302

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/15/2024

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